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[e-drug] Patient groups and drug company sponsorship

E-drug: Patient groups and drug company sponsorship
---------------------------------------------------
[How independent is the advice coming from patient groups? Several chronic
disease patient groups have a need to discuss their chronic medication, and
they could be very helpful in providing feedback to doctors and drug
industry. However, how close can their financial ties become, and when are
they becoming a voice for drug companies marketing techniques?
Maybe we should develop a code of conduct for patient groups?

Copied as fair use. Source:
http://www.theage.com.au/articles/2003/12/12/1071125658355.html
WB]

Taking your medicine

December 13, 2003

Many of us with chronic health problems rely on advocacy groups and peak
medical bodies for independent advice and support. But just how independent
is that advice and are we being given the full picture?

The Age has found that many advocacy groups are becoming hooked on
sponsorship dollars from drug companies and these international corporations
are in turn using them to promote their products in Australia's booming $5
billion drug market.

Gary Hughes and Liz Minchin follow the big pharmaceutical money trail to
reveal who is really behind the health advice we are getting.

ASTHMA


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 an earlier existence. He began life as the registered trademark
used by international pharmaceutical giant GlaxoSmithKline to market one of
its asthma drugs, Seretide, to doctors. His colour matches the packaging for
Seretide.

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

GlaxoSmithKline, which is the world's biggest seller of asthma medications,
also provided financial support for the television campaign and to develop
an interactive internet quiz for the NAC website to check whether someone's
asthma was under control. Even if you answer "no" to the initial question
"do you have asthma?" and say you have no symptoms, Puff advises you that
your asthma appears to be under control, but you should visit your doctor
anyway for a medical review.

NAC chief executive Kristine Whorlow defends the use of a pharmaceutical
company logo to spearhead a supposedly independent 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 interest.

"When GSK was talking to us and we were talking to them about doing another
consumer campaign and they came up with the idea of using Puff, we discussed
that very thoroughly here at our board meetings and we decided to go ahead
with it," she said.

"But we only went ahead with it when we looked at the consumer research
showing that the consumers were not aware of the dragon at all."

Ms 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 on such a campaign.

GlaxoSmithKline was the founding sponsor of the council when it was 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 Ingleheim, Schering-Plough,
Merck, Novartis and Proctor and Gamble.

According to Ms Whorlow, up to 60 per cent of the council's annual budget of
between $800,000 and $1 million comes from the pockets of international
pharmaceutical companies.

When the council launched a new edition of its Asthma Management Handbook in
March last year, GlaxoSmithKline was there again as sponsor of the
publication. 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 a
successful one for GlaxoSmithKline. In December last year a briefing paper
prepared by Hill and Knowlton internationally boasted how 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 products.

Ms Whorlow accepts that pharmaceutical companies view sponsorship as a
marketing exercise.

"The reality of having a sponsorship, whether it's with a pharmaceutical
company or a broom company, is that they want an advantage out of it as
well," she says. "It may be general good corporate citizenship, but more
often nowadays, to be absolutely realistic about sponsorship, it is because
of increased market share.

"The old days of philanthropy have by and large gone. You get some companies
which wish to have a focus on good corporate citizenship, although there is
less of that around now.

"Companies want to sponsor causes allied to their marketing potential."

Ms Whorlow said the NAC and its sponsors shared a common goal "because we
want more people on long-term preventative medication so they don't
experience serious asthma symptoms".

The independence of the council was protected by a set of strict guidelines,
including the retention of editorial control over publications and the
ability of NAC spokespeople to speak freely. But the guidelines also provide
for details of individual sponsorship contracts, including the amounts
involved, to be kept secret.

"We would never be associated with anything that put forward a wrong or
incorrect message," Ms Whorlow said. "Our credibility, our reputation, is
the most important thing to us."

The NAC also uses World Asthma Day, held in May each year, as a key part of
its strategy to raise community awareness. Since 1998, World Asthma Day has
been run 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. It is operated by an
American company called Medical Communication Resources, which describes
itself as helping the pharmaceutical industry "find solutions to significant
marketing and education challenges" through promoting, repositioning or
launching products.

Medical Communications Resources also does the behind-the-scenes
co-ordination of World Asthma Day and the company's chief, Dr Larry Grouse,
is listed as a member of GINA's executive committee.

GINA's sponsors provide money to leading international asthma experts to
gather several times a year, normally at four or five-star hotels in Europe,
to discuss the latest research as part of their role in drawing up
international treatment guidelines for asthma.

Most of those same sponsors are also the financial backers of another
international group, the Global Initiative for Chronic Obstructive Lung
Disease or GOLD, that is almost a mirror of GINA and also operated by
Medical Communications Resources.

Like GINA, GOLD also runs a World Chronic Obstructive Pulmonary Disease Day
each year and has Dr Grouse listed as an executive committee member.
Websites for the two groups, that are maintained by Medical Communications
Resources, are virtually identical.

Indeed GINA and GOLD operate so closely that at a meeting of GOLD sponsors
in London in February it was suggested that future meetings for drug company
supporters of the two groups be combined for convenience.

Global treatment guidelines developed by GINA and GOLD medical advisers for
asthma and chronic obstructive pulmonary disease have been used as models
for treatment guidelines issued by Australian medical organisations that
have links to the two groups.

To help promote the adoption of its international asthma treatment
guidelines, GINA set up another group called the International Asthma
Quality of Care Initiative. The group is also run by Medical Communications
Resources and is funded by GINA's pharmaceutical company sponsors.

The latest asthma treatment guidelines will be launched in Melbourne in
February at the annual conference of the International Primary Care
Respiratory Group, a global umbrella group for respiratory care
organisations.

The IPCRG is sponsored by six international drug companies, including
GlaxoSmithKline, Boehringer Ingelheim, Novartis and Merck. The IPCRG's
Melbourne conference, which is being hosted by the National Asthma Council,
is also being sponsored by pharmaceutical companies.

Ms Whorlow said she was unaware of Medical Communications Resources' role in
helping drug companies market their products, but defended the integrity of
treatment guidelines developed by GINA and GOLD.

The guidelines had been developed by "the world's experts in asthma" and
they would never compromise themselves with pharmaceutical companies, she
said.

The reality was that not-for-profit organisations such as the NAC found it
hard to raise money, particularly as it did not have tax deductibility
status to help it attract public donations.

"There are no other options. We've got to have corporate sector support,"
she said.

HEPATITIS


When international pharmaceutical giant GlaxoSmithKline wanted to push more
deeply into the Australian market with its hepatitis B vaccine, it did not
hesitate.

It used a technique that had already proven so successful in France that it
convinced that country's population at large there was a huge threat of
contracting hepatitis B and saw a huge jump in profits.

So in 1995 it used its public relations company Hill and Knowlton to set up
the Viral Hepatitis Prevention Board to tell Australians how at risk they
were and 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.

Their airfares and other expenses were paid to attend board meetings around
the country organised by Hill and Knowlton, while material warning of the
risks of hepatitis B prepared by the public relations company was released
under the board's name.

"The idea basically came from GlaxoSmithKline (then SmithKline Beecham) who
used Hill and Knowlton as their PR company and they basically did quite a
lot of the organising, they provided the secretariat and so on for the
meetings," admits board chairwoman Dr Sandy Thompson.

"It always is a little bit of a difficult relationship, I suppose, because
clearly they are in the business of wanting to sell vaccines."

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

But GlaxoSmithKline also had a vaccine against hepatitis A and so the board
began targeting the risks of that version of the virus, just as its European
counterpart had done a few years earlier.

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 made no mention that GlaxoSmithKline made the hepatitis A
vaccine, which costs $120 for a two-dose course of injections.

The booklet also warned of the dangers from measles, rubella and chickenpox,
for which GlaxoSmithKline also markets vaccines.

In April this year a member of the hepatitis prevention board, Professor
Graham Cooksley from Royal Brisbane Hospital, chaired a satellite symposium
in Sydney funded with a grant from GlaxoSmithKline on the topic: "Should we
move towards universal vaccination for hepatitis A?"

Dr Thompson says the Viral Hepatitis Prevention Board has now "basically
gone into recess" because members felt "we had run our course a little bit".

She said board members had been keen to try to do something in the area of
hepatitis C, but this had created a "difficult issue" with GlaxoSmithKline,
because the company did not have a vaccine it could sell.

"That wasn't something that GSK had any vested interest in," she said.

But Dr Thompson rejects any suggestion that there was any conflict of
interest surrounding her role with the board.

"I work in public health, so there was no conflict for me in trying to
prevent viral hepatitis," she said. "I didn't see that as conflict of
interest. Immunisation is one of the success stories of public health. We
need to promote immunisation, we need to use vaccines effectively. So I
didn't feel any conflict of interest.

"I know often these boards and expert panels people get paid, but basically
with VHPB we didn't get paid.

"I think we were just pleased to have the opportunity to do a bit of
lobbying in an area that most of us believed in."

GlaxoSmithKline has also targeted another potential growth market for its
hepatitis vaccines through a second organisation it funded, the Travel
Health Advisory Group.

In September the group released, through Hill and Knowlton, details of a
survey funded by GlaxoSmithKline showing that more than half of the
Australians travelling overseas did not seek medical advice about the risks
of such diseases as hepatitis A and B.

The press release quoted the chairman of the group, Dr Bernie Hudson from
Sydney's Royal North Shore Hospital, warning of the dangers of the two types
of hepatitis.

It did not mention that the survey, originally published in the Medical
Journal of Australia, had been funded by GlaxoSmithKline.

Dr Hudson did not return calls from The Age.

One of the members of the travel group is Viral Hepatitis Prevention Board
member Dr Tilman, the medical head of GlaxoSmithKline's vaccine division.

HRT


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 this year that they had invented it to sell more drugs.

One of the companies in the race for a slice of the huge HSDD profits is
United States giant Procter and Gamble. And one of the key pieces of
evidence it is using to support the effectiveness of a testosterone patch
for women that it has developed is a clinical trial partly done in Australia
by the Melbourne-based Jean Hailes Foundation. Procter and Gamble financed
the trial.

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

Professor Davis, who has previously declared accepting honorariums for
lectures and consulting from drug companies Organon, Novartis and Servier,
insists she is staunchly opposed to so-called "disease mongering" by
pharmaceutical corporations in the search for new markets.

"We shouldn't be creating a disease out of it," she says. "On the other
hand, for those who have a problem, it shouldn't be that we shouldn't seek
options for those women."

But a report following her appearance at the Texas meeting was headlined
"Testosterone Improves Sexual Function in Women with Hypoactive Sexual
Desire Disorder".

Last year, the giant Dutch pharmaceutical company Organon flew Professor
Davis to France to take part in a meeting it sponsored of international
experts to discuss "the true impact of reduced sex drive" on menopausal
women.

After the meeting, Organon issued a media release saying that doctors
underestimated the impact reduced sex drive has on women. It quoted
Professor Davis as saying that Organon's hormone product, Livial,
consistently improved sexual well-being in menopausal women, unlike other
hormone replacement therapies, and as praising its lack of side effects.

Professor Davis defends her trip to Texas, but admits the Organon-sponsored
appearance in France was, on reflection, as mistake. "Would I go to that
meeting again? No. Sometimes you can end up in a place you don't want to
be."

The trip to Texas was justified because the clinical trial paid for by
Procter 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," she says. "We shouldn't discredit really
quality research that is done by the pharmaceutical industry."

Professor 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.

The Jean Hailes Foundation, which is attached to Monash University's
department of obstetrics and gynaecology, relies on pharmaceutical company
funding for about 10 per cent of its budget. Present research projects
include two sponsored by Procter and Gamble and one by Organon.

It is conducting three studies involving low libido in menopausal women.

Last month, Professor Davis presented results of research on testosterone
patches funded by Procter and Gamble at the Australasian Menopause Society's
annual meeting in Hobart. The meeting, at which Professor Davis was
installed as president of the society, was funded by pharmaceutical
companies Wyeth, Organon, Novo Nordisk, Servier, Pfizer, and Merck Sharp &
Dohme.

The Menopause Society was criticised last year for issuing a booklet on
menopause paid for by Wyeth, the market leader in hormone replacement
therapy, that played down the risks of cancer.

"I have no relationship with Wyeth," says Professor Davis.

"I don't think I have given a lecture for Wyeth for five or 10 years."

Professor Davis concedes that drug companies sometimes use positive research
results to promote their products, but says the foundation "will not do
studies that are purely marketing studies". The foundation has agreements
with sponsors to ensure its independence in research and will publish
negative results as well as positive.

Professor Davis says researchers needed to be aware that the drug industry
had a vested interest in having more drugs prescribed.

HERPES


Click on the sponsorship link on the Australian Herpes Management Forum's
website and everything seems to be upfront: "The AHMF is sponsored by
GlaxoSmithKline Australia and Novartis Pharmaceuticals via open educational
grants.

"GlaxoSmithKline is the founding sponsor of the Australian Herpes Management
Forum and the major sponsor for 2003."

But there is something that visitors to the AHMF's website are not told: the
group relies entirely on Australia's main herpes drug manufacturers for its
existence, and has since it was set up in 1996.

Recently appointed AHMF executive director Trish Berger estimates that in
the past financial year, GlaxoSmithKline has given the AHMF about $120,000,
or some 80 per cent of its budget. The other 20 per cent comes from
Novartis.

There is a strong bond between the AHMF and GlaxoSmithKline, for many years
the only major manufacturer of herpes treatments in Australia.

Its constitution was written by Glaxo Wellcome's (now GlaxoSmithKline)
Melbourne-based law firm, Deacons, and up until August this year the forum's
administration was run by public relations firm Edelman, hired on the
recommendation of a well known client - GlaxoSmithKline.

Not surprisingly, Edelman's media releases about herpes on behalf of the
AHMF often bore a striking resemblance to those written by the same
consultants for GlaxoSmithKline.

Most of the herpes experts who have sat on the AHMF board have also worked
with or advised GlaxoSmithKline and Novartis in recent years.

This year the AHMF board has begun to nudge its sponsors away to arm's
length, moving to end Edelman's control of the organisation's secretariat.
The organisation also created its first paid staff position, Ms Berger's.
Her job includes seeking government and other non-pharmaceutical funding.

Ms Berger is keen to see the AHMF distance itself further from its sponsors,
to avoid them "competing through us to get their time and profile enhanced".

AHMF chairman Professor Adrian Mindel concedes that the forum has been
vulnerable to pressure from GlaxoSmithKline and Novartis because without
their funding, "the Australian Herpes Management Forum would cease to exist
tomorrow".

But Professor Mindel, who is also professor of sexual health medicine at
Sydney University, director of Westmead Hospital's sexually transmitted
infection research centre and on the editorial board of the international
journal Herpes, insists that the forum and its board have remained
independent of their benefactors.

"We're all professionals who are mostly academics in this area, and
protecting our own reputations and independence is also terribly
important... We think it is a quid pro quo (arrangement) and that we gain
some benefit from that by promoting the science and improving the general
health of the community. And they get the benefit in terms of their drug.
And I'm not sure it's possible to completely separate the two."

In contrast, Professor Mindel says the global version of the AHMF, the
International Herpes Management Forum, may be a different story.

He says although the IHMF "produces some very high quality material...
whether it is completely unbiased I think is sometimes questionable" because
of its close ties to drug companies.

The AHMF is one of 21 national organisations modelled on the IHMF, which was
set up in 1993 to be "an authoritative voice on issues relating to the
management of herpes infections". It was a worthy aim, with a wealthy
backer.

GlaxoSmithKline has provided a steady income for the IHMF, funding its
Herpes journal, sponsoring research awards and paying for the creation of
herpes management guidelines intended for international adoption.

Today Glaxo is one of three pharmaceutical companies, along with 3M
Pharmaceuticals and Novartis, keeping the IHMF afloat.

More than half of the current IHMF board have links to GlaxoSmithKline, such
as leading trials of its herpes drugs, or in one case featuring in a
Glaxo-sponsored television special.

In December 1999, the IHMF spawned a patient offshoot, the International
Herpes Alliance, which also relied on GlaxoSmithKline funding to get
started.

Novartis has since signed on as a sponsor too, and the companies' influence
pervades the IHA website. Its "educational" material for journalists has
been written by the "organisations (that) have made educational
contributions to the International Herpes Alliance for the promotion of
herpes awareness" - in other words, GlaxoSmithKline and Novartis.

COPD


World Chronic Obstructive Pulmonary Disease Day was launched globally,
including in Australia, in November last year.

But the concept was born nine months earlier at London's Radisson Hotel
during a meeting between pharmaceutical company executives and medical
experts.

The experts were members of the executive committee of an organisation
called Global Initiative for Chronic Obstructive Lung Disease, or GOLD. The
organisation was sponsored entirely by the pharmaceutical companies
attending the meeting and the airfares and hotel expenses for the medical
experts had been provided.

Minutes from the meeting show that "the committee and sponsors discussed the
development of a World COPD Day and suggested that the feasibility and
objectives... be discussed".

Nine months later World COPD Day was duly launched using promotional
materials prepared by GOLD and with the aim of raising public awareness of
the threat posed by chronic lung diseases.

In Australia, the local version of the campaign was spearheaded by the
Australian Lung Foundation, the consumer and research arm of the Thoracic
Society of Australia and New Zealand.

No mention was made that the pharmaceutical companies providing the money to
run GOLD were also some of the biggest players in the global respiratory
medicines market, including the world leader GlaxoSmithKline.

Nor was it obvious that the Australian Lung Foundation's launch was also
partly funded by GlaxoSmithKline and another international pharmaceutical
heavyweight, Boehringer Ingelheim.

And even harder to pick was that the company that runs GOLD was an American
communications corporation that boasts on its website of helping the
pharmaceutical industry "find solutions to significant marketing and
education challenges" through such techniques as promoting brands and
repositioning or launching products.

Dr Larry Grouse, the chief executive of the company Medical Communications
Resources Inc, is also the co-ordinator of GOLD and listed as a member of
its executive committee.

"No, I wasn't actually aware of that. Thanks for pointing that out," says
William Darbishire, the chief executive of the Australian Lung Foundation,
which is setting up a national call centre to provide advice to COPD
sufferers with a $US20,000 ($A27,000) grant from drug giant Pfizer.

MCR and virtually the same set of sponsors are also behind an international
organisation called Global Initiative For Asthma, or GINA.

Both GOLD and GINA have developed global treatment guidelines for treating
COPD and asthma, which in turn have been used as models for Australian
treatment guidelines.

Dr Christine Jenkins is an independent Australian representative on GOLD's
executive committee as well as being the head of clinical trials at Sydney
University's Woolcock Institute of Medical Research, which received a $1
million endowment from GlaxoSmithKline.

She strongly rejects any suggestion that the pharmaceutical industry
sponsors of GOLD and GINA could influence the setting of guidelines for the
types of drugs doctors are advised to use to treat asthma or chronic lung
disease.

"I think GOLD is a very, very independent process," said Dr Jenkins, who
helped launch Australia's first COPD Day at a Lung Foundation media
conference last year.

When GOLD issued updated treatment guidelines in July the medication
tiotropium, marketed by Boehringer Ingelhein and Pfizer as Spiriva, was
added to the list of recommended medications. The companies issued a media
release quoting Dr Larry Grouse, but failed to mention their financial
support of GOLD.

Five months earlier, when Spiriva was launched on the Australian market,
Pfizer and Boehringer issued a local media release through public relations
company Hill and Knowlton quoting Dr Jenkins on the dangers of COPD.

Dr Jenkins said tiotropium was "an excellent drug" and it should be expected
that pharmaceutical companies would use such decisions to help market their
products.

"I think the companies will use GOLD, there's no question," said Dr Jenkins,
who has her airfares and accommodation paid for by GOLD's drug company
sponsors when she attends executive meetings.

"That's their business, to sell their drugs."

DIABETES


In July last year, retired swimmer 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, 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 O'Neill's 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 major international pharmaceutical company
Merck, which also sells diabetes treatments.

Although the sponsorships were not mentioned on the television commercial,
which only displayed 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 success.

"Basically 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
products. (But) we couldn't afford to get it out there as effectively and
efficiently as it could be through the 'field force'."

Mr 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 fund-raising and has attracted a
long, varied list of corporate sponsors.

Under the heading "corporate sponsorship and branding opportunities", the
NSW website boasts its campaigns provide "excellent return on investment"
and says the BGL campaign offers "unique branding and market expansion
opportunities for all types of businesses".

Mr Edmonds says good publicity is the only benefit pharmaceutical sponsors
such as AlphaPharm and Abbott get from their involvement, and that no
sponsor has ever pressured him to get more for their money.

But he admits he has voluntarily "gone overboard" to thank the BGL campaign
supporters, quoting them in press releases and even preparing a Powerpoint
presentation for AlphaPharm's sales staff this year about the effectiveness
of the 2002 awareness campaign.

This year, Edmonds says only AlphaPharm, Merck and Novo Nordisk have
supported the organisation, giving about $100,000, not including
non-financial aid such as visiting doctors. In the past few years, Diabetes
Australia has also won support from other diabetes drug producers, such as
Aventis, Bayer, Eli Lilly, GlaxoSmithKline, Parke Davis (now part of
Pfizer), Roche and Servier.

Compared with many consumer groups, Diabetes Australia and its NSW branch
have massive budgets, around $93 million and $8 million respectively for the
past year, although most of that money is tied up in administering the
National Diabetes Services Scheme for the Federal Government.

However, Diabetes Australia's executive director, Brian Conway, says rather
than avoiding any chance of conflicting interests, they choose to accept the
funding and in-kind support because "it still helps".

One such potential conflict of interest is when Diabetes Australia or its
members lobby for diabetes drugs to be added to the Pharmaceutical Benefits
Scheme (PBS).

For two years, the organisation pressured the Government to add
Glaxo-produced Avandia and Actos, made by Eli Lilly, to the PBS (they were
finally listed in October this year). But Mr Conway denies that both
companies' past support for diabetes research and campaigns helped win
Diabetes Australia's lobbying support.

DEPRESSION


Leanne Pethick is the woman behind DepressioNet, an apparently independent
consumer website for people suffering from depression that claims to attract
more than 1 million visits every three months.

And international pharmaceutical giant Wyeth, which markets antidepressants,
is the company behind Leanne Pethick.

"DepressioNet would not exist today without Wyeth," Ms Pethick readily
admits. "Wyeth is a company I am extremely proud to be associated with."

Wyeth has provided $150,000 over the past three years to keep the
Melbourne-based DepressioNet running. But the links do not stop there.

Ms Pethick is also on the editorial board of Wyeth's own depression website
Yes To Life, and is a member of DepressioNet's medical advisory board. The
Yes To Life website links through to DepressioNet, which it describes as "an
independent resource", without disclosing that it is substantially funded by
Wyeth.

Ms Pethick helps with training seminars for Wyeth's sales team and last year
took part in a promotional tour the pharmaceutical company organised for a
visiting US depression expert, Professor Martin Keller.

Ms Pethick even thanked Wyeth on her website for the opportunity to help
with the national tour, which saw her costs paid by the company to take part
in panel discussions at meetings of doctors.

But what Wyeth did not tell Ms Pethick was that Professor Keller had been at
the centre of a row in his home town of Boston in 1999, when The Boston
Globe reported he failed to disclose more than $500,000 in consulting fees
from pharmaceutical companies, including Wyeth. The newspaper alleged
Professor Keller had praised the products of the companies at conferences
and in journal articles.

"No I wasn't aware of that," Ms Pethick told The Age. "On that particular
tour, no particular product was mentioned."

DepressioNet's stated aim is to "significantly increase the proportion of
Australian depression sufferers who seek help and treatment".

Ms Pethick, who started the website in 2000 after her own battle with
depression, agrees that encouraging more people to seek medical treatment
will expand the market for antidepressants in Australia. But she sees no
conflict of interest in accepting drug company sponsorship.

She also insists her website, which also received a one-off grant of $20,000
from another pharmaceutical giant and the makers of Prozac, Eli Lilly, is
able to remain independent.

"The money we got from Wyeth was totally unconditional and helped us and
continues to help us to provide a vital service," she said.

"Any money we get, we disclose."

When her own savings ran out in 2001, Ms Pethick deliberately approached
companies in the antidepressant market because she thought they would be
more interested in sponsorship.

DepressioNet is not the only non-profit organisation advocating for patients
with mental illness that receives pharmaceutical industry financial backing.

The peak national body Sane Australia, the operating name of the
Schizophrenia Australia Foundation, relies on drug companies for about 25
per cent of its annual $1 million budget.

Last year Sane Australia used a grant from Novartis Pharmaceuticals, which
markets two schizophrenia drugs, to commission an Access Economics report on
the cost of schizophrenia to the community. The report found that many
sufferers were missing out on treatment and said some newer medicines could
be "extremely effective" in reducing symptoms.

Earlier this year Sane used a grant from GlaxoSmithKline, which markets a
lithium-based drug for bipolar disorder, to commission a second Access
Economics report, this time on the cost of bipolar disorder to the
community. The report found that average treatment levels for sufferers was
less than a quarter of what was considered best practice.

Sane Australia's executive director, Barbara Hocking, said the organisation
accepted only unrestricted educational grants from pharmaceutical companies.
"We receive grants for specific purposes. The purposes we receive them for
are driven by us. We have our own guidelines," she said.

Sane deliberately targeted Novartis and GlaxoSmithKline to fund the two
Access Economics studies because they produced drugs in those markets.

"The reality is you go to where you feel the money is likely to come from
and it is precisely because those companies have products in that area that
we felt they would be interested in having this independent information," Ms
Hocking said.

ARTHRITIS


Two years ago, the Australian Rheumatology Association decided to get tough
with its national executive members who were involved with drug companies.

To avoid the faintest whiff of conflicting interests, the executive was told
to sever all ties to pharmaceutical companies or resign.

It didn't last.

"It was felt that in a small organisation this is a difficult thing to
sustain," says association secretary, Associate Professor Geoff McColl.
"There was some consideration that it may have limited the pool of
individuals who might serve on the executive."

Although the association is mainly a professional body for rheumatologists,
who specialise in diseases of the joints, muscles, and connective tissues,
it also sees itself as a patient advocate.

Instead of banning relationships with drug companies, the ARA now insists
that its executive members put any conflicts of interest on the record. But
those disclosure documents are available only to other ARA members, rather
than being open to public scrutiny.

As well as sponsoring a number of the ARA's research and educational
projects, each year drug companies such as Pfizer, Schering-Plough, Wyeth,
Abbott and Merck pay for its annual scientific meeting. Next year's
conference is being held in Cairns.

Dr McColl defends the drug-funded subsidy, saying some of his colleagues
could struggle to attend if their costs shot up from around $600 to several
thousand dollars.

"We are grateful to our pharmaceutical colleagues, particularly as we
believe, and I don't think there's any evidence to the contrary, that it
doesn't alter our decision-making," Dr McColl says. "Now, whether it has a
more global effect on individuals' views of particular companies, that's a
much more difficult thing to quantitate."

Just how easily patient advocates can be swayed by relationships with drug
companies was illustrated three years ago in a case involving Dr McColl and
Arthritis Australia.

In July 2000, the ABC's Media Watch exposed how a seemingly independent
advertising campaign by the then Arthritis Foundation of Australia was used
to sell the new arthritis treatment, Celebrex. The drug's co-marketers,
Pfizer and Pharmacia, gave the Foundation an unconditional grant of
$250,000. The money was spent on television and print ads telling people to
"ask your doctor about exciting new arthritis treatments".

Callers to the arthritis hotline were reportedly told "there's this new
whizzbang drug called Celebrex" and offered a phone number to find out more
information.

Former Arthritis Foundation director Ian Hook apologised, saying "it won't
happen again", but that didn't stop Celebrex quickly becoming one of the top
selling drugs in Australia.

At the time, Dr McColl was on Pharmacia's medical advisory board and was one
of the reassuring public faces of the media and marketing blitz.

He now regrets that involvement, saying he wouldn't be part of another drug
marketing campaign.

"I think that taught us how powerful a direct-to-consumer marketing campaign
can be and I think really there should be some legislation or guidelines so
that doesn't occur (again)," he says.

"I've been made aware that if you work closely with these people your views
can be subtly altered, and that that's fine as long as everyone knows that
might have happened. And it's probably better ideally if you don't get
involved."

Dr McColl's relationship with the Pharmacia advisory board ended 18 months
ago. He now advises Schering-Plough, makers of another rheumatoid arthritis
treatment.

All the key decision makers at Arthritis Australia who approved the Celebrex
campaign have since left, and new president Ita Buttrose says she couldn't
comment on why it went ahead.

But she vows "as long as I am president, Arthritis Australia will not allow
itself to be a disguised front for any pharmaceutical company or accept
donations 'with strings attached'".


This story was found at:
http://www.theage.com.au/articles/2003/12/12/1071125658355.html

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