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So you’re finding yourself thirsty all the time — a lot more than usual. Or you’ve been really, really tired lately. Can’t seem to get
enough sleep.
Maybe you’ve dropped a bunch of weight — without even trying. Funny, but these days, it seems you always have to go pee, even when you’ve just gone.
You dismiss it all as just something you’re going through. Somethingthat will pass.
Well, it could be that you’ve developed something that’s going tostick around for the rest of your life.
You could be one of the almost 250 million people around the world who has diabetes. A third of those people aren’t even aware they have the condition. Forty-six per cent of them are between 40 and 59 years old.
Quick facts 2007 2025
World population (billions) 6.6 7.9
Number of people aged 20-79 years with diabetes (millions) 246 380
World diabetes prevalence (%) 7.5 8.0
Source: Diabetes Atlas: International Diabetes Federation
Two million of them are Canadian.
Diabetes — or complications from the disease — now kills 3.8 million people a year or about the same number as HIV/AIDS.
(Read the article)
Refrigerated Drug Product List
Abciximab 2-mg/mL injection
Allergen extract concentrate
Alprostadil injection
Alteplase
Atracurium injection
Becaplermin 0.01%
Botulinum toxin type-A 100 units
Calcitonin injection
Calcitonin nasal spray
Calcitonin salmon intranasal
Candida albicans skin test
Cisatracurium injection
Conjugated estrogens injection
Dacarbazine for injection
Daptomycin for injection
Darbepoetin alfa
Digoxin immune fab (ovine)
Diphtheria and tetanus toxoids and acellular pertussis adsorbed,
hepatitis B (recombinant) and inactivated poliovirus vaccine combined
Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed
Dornase alfa
Epoetin alfa multidose
Epoetin alfa single dose
Eptifibatide 2 mg/mL
Erythromycin ethylsuccinate oral suspension
Etanercept powder
Etanercept prefilled syringe
Etoposide injection
Exenatide
Famotidine
Filgrastim vials and Singleject prefilled syringes
Fosphenytoin sodium injection
Glatiramer acetate injection
Hepatitis A vaccine, inactivated
Hepatitis A vaccine, inactivated
Hepatitis B immune globulin (human)
Hepatitis B vaccine (recombinant)
Immune globulin (human)
Influenza virus vaccine
Insulin as part (rDNA origin) injection
Insulin glargine (rDNA origin) vial or cartridge
70% insulin aspart protamine suspension and 30% insulin as part
injection (rDNA origin) pen fill cartridge
70% insulin aspart protamine suspension and 30% insulin as part
injection (rDNA origin) vial
Lente human insulin (rDNA origin) zinc suspension
Insulin lispro (rDNA origin) vial
NPH, human insulin isophane suspension (rDNA origin)
Regular human insulin injection (rDNA origin)
Humulin Ultralente human insulin (rDNA origin) extended zinc suspension
Hyaluronic acid
Interferon beta-1a i.m. injection
Interferon beta-1a s.c. injection
Latanoprost 0.005% ophthalmic solution
Lopinavir/ritonavir capsules
Lopinavir/ritonavir oral solution
Melphalan 2-mg tablets
Methylergonovine maleate injection
Neomycin sulfate-polymixin B sulfate solution for irrigation
Octreotide acetate injectable suspension
Palivizumab powder and solution
Pancuronium bromide injection
Peg-interferon alfa-2a vial
Peg-interferon alfa-2a vial prefilled syringe
Penicillin G benzathine injection suspension
Penicillin G benzathine and penicillin G procaine injection suspension
Pneumococcal 7-valent conjugate vaccine (diphtheria CRM197 protein)
Proparacaine hydrochloride ophthalmic solution
Quinupristin-dalfopristin for injection
Rabies immune globulin (human) solvent/detergent treated
Rabies vaccine
Ritonovir capsules
RhoD immune globulin (human)
Rocuronium bromide
Saquinavir soft gelatin capsules
Succinylcholine chloride multidose
Tetanus immune globulin human solvent/detergent treated
Tipranavir capsules
Tobramycin inhalation solution
Trifluridine ophthalmic solution
Vinorelbine tartrate injection
Vitamin A
A B.C. woman’s death last year from metal toxicity underlines the
dangers of buying medications through the internet, says the regional
coroner for Vancouver Island.
Marcia Bergeron, 57, of Quadra Island died last December from a heart
attack brought on by toxic metals in her system. Toxicology tests
found the concentration of aluminum in her liver to be 15 times the norm.
A coroner’s inquiry found on Thursday the toxins came from counterfeit
medicines Bergeron had ordered online.
Coroner Rose Stanton warns that the practice of buying cheap drugs
online is increasing and that there are very few safeguards for consumers.
“It’s certainly happening at a significant enough rate that it can
keep these people in business who are selling the drugs.
“And people who are buying are people who for one reason or another
can’t get to a pharmacy … or they don’t want people to know the drug
they are purchasing,” Stanton told CBC News.
“It’s no surprise that the leading drug purchased over the internet is
Viagra.” Provincial Health Minister George Abbott echoed Stanton’s
warning, saying that although the federal government regulates
internet trade, the sale of drugs online appears to be uncontrollable.
“There is no way for Health Canada or anyone else to ensure the safety
of the product that is coming to the recipient when it’s purchased
over the internet,” he told CBC News.
Evidence gleaned from Bergeron’s computer suggests she had ordered
sedative and anti-anxiety drugs over the internet. Unmarked packages
were also found in her home.
The coroner’s report noted that internet drug sites selling
counterfeit medication are a complex and emerging health-care problem,
but made no recommendation on how to put a stop to it.
THE pharmaceutical industry defends its promotional spending as a
service to science, physicians and patients. Advertising to patients
helps motivate them to improve their health, manufacturers say, and
detailing doctors keeps them abreast of new therapies and scientific
advances.
Those activities also, indisputably, boost sales. As marketing budgets
climbed toward a 2006 high of $28 billion, sales of prescription drugs
have never been higher. According to estimates published by the Kaiser
Family Foundation, the number of individual prescriptions filled in
the United States rose from 2.9 billion in 1999 to 3.7 billion in
2006; in 1994, Kaiser calculated that each American filled on average
7.9 prescriptions per year, including refills; by 2005, that number
had risen to 12.4.
For every 10% increase in direct-to-consumer advertisements within a
class of similar drugs, sales of drugs in that class (say,
antidepressants or erectile dysfunction drugs) went up 1%, Kaiser
found in a 2003 study. In 2000, direct-to-consumer advertising alone
boosted drug sales 12%, at an additional cost of $2.6 billion to
consumers and insurers.
Of more than 10,000 drugs on the U.S. pharmaceutical market, half of
all marketing budgets are used to promote 50 brand-name medications,
according to a 2003 study in the journal Clinical Therapy. And those
50 drugs are the ones that sell the best.
Prodding patients to prod their physicians, apparently, works. In
2006, a Kaiser Family Foundation survey of 834 office-based physicians
found that 28% of doctors said patients “frequently” asked for
prescription drugs by name after seeing an advertisement. Although
about half said they typically responded by suggesting lifestyle
changes, 14% of the physicians said they would, in many cases,
prescribe a different drug in the same class as the one the patient
requested. And 5% readily acknowledged that they frequently would
prescribe the drug the patient requested.
Physicians see marketing’s effects on their patients every day. But
ask the doctors whether the marketing influences their clinical
judgments or prescribing behavior, and a chill will descend upon the
room, say those who have run the experiment.
“Physicians are heavily socialized to believe that they have risen
above the normal human foibles,” said Harvard University’s David
Blumenthal, co-author of the most recent survey detailing doctor-drug
company interactions. “They clearly recognize that physicians are
human and subject to normal human influences; they just have a lot of
trouble seeing themselves as subject to that.”
Not immune to marketing
BLUMENTHAL finds it revealing that most physicians do not extend to
their colleagues the same trust. In a widely cited 2001 study
published in the American Journal of Medicine, 84% of young physicians
surveyed said they believed that drug industry promotions, including
gifts and meals, influenced the prescribing practices of fellow
physicians. Although most of these doctors acknowledged they were
besieged by back-slapping, sample-toting, gift-giving drug
representatives, 61% said they considered themselves immune to
marketing’s effects.
They are not. A 1994 study found that hospital-based doctors were more
likely to request the addition of brand-name prescription drugs to
their institution’s medicine chest after they had met with sales
representatives detailing those drugs.
Studies published in 1988 and 1992 found that physicians who attended
continuing medical education programs sponsored by drug companies, or
who accepted funding for travel and lodging to attend them, were
significantly more likely to prescribe that company’s drug than those
who did not.
Several studies have found that physicians who accept and hand out
free samples to their patients are far more likely to prescribe those
drugs than those who don’t take or have no access to samples.
Last April, the online medical journal Public Library of Science
published a study tracking the effect of doctor-detailing by sales
reps working for Warner-Lambert, maker of the anti-epileptic drug
Neurontin. The study showed that, following even a brief encounter
with a marketing representative detailing Neurontin, almost half of
the 97 physicians examined found their briefings highly educational
(even when research evidence presented was scant or poor) and
indicated they would step up prescriptions of the drug.
Dr. Andrew Leuchter has spent much of the last two years heading a
UCLA committee convened to redraft guidelines for physicians’
interactions with drug companies. He has faced the skepticism of
physicians when the subject of drug company influence is raised.
“They ask, ‘Do you really think that my medical decision-making can be
influenced by the fact that someone bought me a pizza?’ ” Leuchter said.
“They’re quite sobered” when confronted with the mounting pile of
evidence that it can, he added.
Subtly powerful
DR. Kurt Stange, the editor of the Annals of Family Medicine who
called for an end to consumer advertising of drugs, said the effects
of a detailing visit can be subtle. But, he added, these encounters
are made all the more powerful when physicians either deny or ignore
their influence.
“You’re not overtly thinking, ‘I’m going to prescribe this drug
because I got a pen,” Stange said. “You’re just thinking, ‘What will
help this patient?’ and you’ve been bombarded with advertisements, and
the name is always before you. . . . You have to have a fair amount of
self-awareness to notice that.”
In the end, advocates of reform say, there is no stronger evidence
that drug marketing influences behavior than the simple fact that drug
companies do market their products — and that they are spending more
money doing it than ever before. The makers of the nation’s
bestselling drugs field on average 4,000 sales representatives to
detail doctors, staff booths at medical meetings and organize trips
and meals for doctors, and spend more than $1 billion per year to
market drugs to physicians alone. They spend, all told, roughly $5
billion a year to advertise directly to consumers. Though they are not
counted in marketing budgets, the funds they dispense to support
research, medical professional organizations and patient-advocacy
groups run into the billions.
In terms of cold, hard return-on-investment, that money was well
spent, says a study unveiled in 2001. Tracking prescription sales for
391 drugs and company marketing budgets from 1995 through 1999,
Dartmouth College marketing professor Scott Neslin has calculated,
down to the penny, how well increases in marketing pay off.
Each additional dollar spent on advertising in medical journals
brought $5 worth of sales of a drug, Neslin found, and an extra dollar
devoted to sponsorship of continuing medical education and
professional meetings yielded an average of $3.56 in sales. A dollar
spent on physician-detailing generated sales, on average, was worth
$1.72. But in the case of the most aggressively marketed drugs, that
dollar generated sales of more than $10.
Appealing directly to consumers was lucrative, Neslin found, but a
little less than wooing physicians. Each dollar spent on
direct-to-consumer advertising generated, on average, increased sales
of $1.37.
Such calculations flesh out a self-evident truth, said, UCLA’s Dr.
Martin Shapiro, a past president of the Society of General Internal
Medicine and an advocate of reform in the relationship: “These are
large and sophisticated organizations. . . . They would not be
spending that money if it didn’t work.”
I am on my third day of 10mg of accutane. I bought accutane 10 mg over the
internet without a doctor. I have my tubes cut, tied, and burnt so I
know I can’t get pregnant. my acne is mild but always there. I
usually end up mopping my face full of oil 5 or more times a day.
I’m a couple months away from being 30 and im so tired of having
constant breakouts. I am getting married at the end of may 2005 so I
think I am only going to take accutane for two months,then quit. Has
anyone taken 10mg for a short period of time and had it work for
them? what about tanning beds when you are done with the medication?
If anyone has any answers or advice please let me know. thanks!!!
Hello everyone. I was wondering how much RX fraud you run into as a
tech? We have relief pharmacists that work once in awhile when my boss
is gone. It seems like everytime my boss is gone, the criminals come
in. Just last week, I recongized a lady that came in with a rx as one
we have to really watch. I alerted the pharmacist and she called the
doctor from a back phone. This lady altered the rx. There is another
lady that has tried everything. She will steal rx pads from the doctors
offices. She alters written rx’s. The last time she called in her own
rx pretending to be a nurse at the doctors office. This lady has worked
the whole area around where I live. She has been caught several times
and seems to always get out again. I have a memory for faces and names
of these people. I don’t forget. How do you handle rx fraud?
WITH vast and profitable markets up for grabs, drug companies are
aggressively reaching beyond doctors and taking their marketing
messages directly to consumers.
Some of their promotional strategies have become hard to miss. Nightly
news broadcasts — a beloved habit for aging Americans — are brought
to you by the makers of prescription medications for high cholesterol,
arthritis, Alzheimer’s disease and erectile dysfunction; an Internet
search for a specific symptom, or a visit to any popular health site,
will bring up sponsored links and blinking ads for at least one
prescription medication used to treat that symptom; fans of NASCAR see
Viagra advertised every time No. 6 Mark Martin’s car rounds the track.
And women paging through a magazine for tips on reducing clutter can
scarcely avoid the faces and personal stories of actresses who are
managing their depression, osteoporosis or hot flashes with a
brand-name pill.
In 1997, the FDA loosened regulations governing the advertisement of
prescription medications directly to consumers. The change set off
explosive growth in marketing aimed at a general audience long on
interest and — compared with physicians — short on professional
skepticism. Today, drug makers spend roughly $5 billion a year to run
advertising campaigns that use many of the same appeals that marketers
use to sell breakfast cereal and toothpaste.
A study published in the Annals of Family Medicine’s January-February
issue analyzed the messages of 38 advertisements then running during
prime-time TV and found that 95% used emotional appeals to sell the
medication, often framing prescription-drug use as a means to regain
lost control over some aspect of life. None mentioned lifestyle change
as an alternative to product use, although roughly 1 in 5
advertisements suggested it might be a useful complement to the drug.
One in 4 described the causes of the disease the advertised drug
treats, who is at risk for it or how frequently the condition occurs
in the population. The study’s authors, led by UCLA researcher
Dominick L. Frosh, suggested that without such information, consumers
would have little reason to see prescription medication as a solution
that involves risks as well as possible benefits.
In all, 58% portrayed the advertised drug as a medical breakthrough –
a pharmaceutical twist on Madison Avenue’s “new and improved” message.
“It is time to ban direct-to-consumer advertising of prescription
drugs,” wrote Dr. Kurt Stange, editor of the Annals, in an
accompanying editorial. The advertisements consumers see “distort the
relationship between patients and clinicians. [They] manipulate a
patient’s agenda and steal precious time away from an evidence-based
primary care clinician agenda that is attempting to promote healthy
behavior, screen for early-stage treatable disease and address mental
health.”
Even after 23 major pharmaceutical companies agreed to a new slate of
voluntary guidelines limiting their advertising, Stange wasn’t buying
it. Self-monitoring, he wrote, “is not working . . . and cannot
realistically be expected to work.”
PhRMA, the drug manufacturers’ industry group, says direct-to-consumer
advertising empowers patients to take an active role in their
healthcare and spurs them to discuss symptoms, diseases and treatment
options with their doctors that might otherwise go unraised. The
industry group frequently cites a 2002 survey of consumers that found
that 43% were spurred by a prescription-drug ad to look for more
information about the drug or their health.
Although direct-to-consumer advertising has spurred the most political
and professional debate, it is only the most visible means of
prescription-drug marketing aimed at the consumer. To build markets
and encourage consumer loyalty to their products, drug makers have
invested heavily in a tactic known to public relations professionals
as “third-party marketing.” Through voices, groups and activities that
seem independent of them — but frequently are not — drug companies
have found another way to get their messages to consumers.
‘Third-party’ approach
ACCORDING to an article published in the British Medical Journal in
2003, the top five public relations firms specializing in healthcare
earned $300 million in 2002. These firms “are expert at ‘third-party
technique’ — helping the drug industry separate the message from what
could be seen as a self-interested messenger,” wrote authors Bob
Burton and Andy Rowell.
Last October, a commentary in the New England Journal of Medicine
detailed one little-noticed third-party marketing venture.
Underwritten by Eli Lilly, the campaign was designed to increase the
use in hospitals of a drug commercially known as Xigris, for the
treatment of sepsis, or blood poisoning. A preliminary study had
suggested some safety concerns with Xigris, and an FDA advisory panel
had urged more thorough study of the drug before its approval. But in
2001, the FDA approved its entry into the market. The controversy
appeared to sap first-year sales of Xigris, which fell short of
Lilly’s expectations.
Lilly’s response was to secure the services of a small public
relations firm, New York-based Belsito and Co. Belsito would begin
spreading the word to physicians and media outlets specializing in
medical news that Xigris was being rationed and that physicians were
being “systematically forced,” because of the drug’s high cost, to
decide which patients would live and which would die. A $1.8-million
educational grant from Lilly would fund the creation of a group of
physicians and bioethicists — named the “Values, Ethics and Rationing
of Care Task Force” — to study this rationing and its ethical
implications. And a Surviving Sepsis campaign was launched “in theory
to raise awareness of severe sepsis and generate momentum toward the
development of treatment guidelines,” wrote Dr. Peter Q. Eichacker and
two fellow investigators based at the National Institutes of Health,
in the NEJM.
Lilly’s financial inspiration of the campaign aimed at physicians,
patients groups and the media was not apparent to many of the
audiences reached. But its effect was quite clear, concluded a case
study of the campaign done by the Council of Public Relations Firms:
Sales of Xigris “have begun to trend upwards. Through the first
quarter of 2004, Xigris sales were up 36%.”
In such campaigns, public relations companies operate as off-site
extensions of a drug company’s marketing department. But sometimes,
the relationship of a drug company and a third-party voice is more
complex. The tie between patient-advocacy groups and drug companies is
a good example.
Drug makers richly support the nation’s proliferating patient-advocacy
groups, and only a handful of the charitable organizations refuse the
sponsorship of pharmaceutical firms, says Georgetown University’s Dr.
Adriane Fugh-Berman, who has studied these ties. That link presents
rich marketing opportunities for corporate sponsors with an interest
in reaching the patients the organizations advise and represent,
Fugh-Berman says. But it also raises real questions about the
independence of patients groups, she adds.
In marketing trade publications, the value of patients’ groups is
widely touted. As friends and allies to potential customers, groups
dedicated to patients who suffer from a specific condition can be
powerful marketing tools. Patients seek information and emotional
support from these groups, and trust them as an unbiased source of
advice. Groups that empower patients to seek treatment are eager to
foster awareness of their disease and, in the process, expand their
membership. When they are successful, patients groups have a natural
market-building effect.
But drug makers have the deep pockets, and patients groups — until
they’re very large and well-established — are constantly scrambling
for money. As a result, according to those calling for reform, the
relationship is not always an alliance of equals.
“There’s an inherent conflict of interest,” says Merrill Goozner,
editor of Integrity in Science, a publication of the Washington-based
watchdog group the Center for Science in the Public Interest. “The
question becomes, ‘Are you doing the best for the patients you
represent, or are you doing the best for your sponsors?’ ”
Goozner says that patient-advocacy groups are especially vulnerable to
carrying drug companies’ messages, untempered by skepticism, directly
to their members. “They’re desperate” for a cure or treatment, he
says. “And no one likes to be told that this latest breakthrough is
not all it’s been cracked up to be,” especially when it’s being pushed
by a company that’s been generous with funding, he adds.
Last October, the magazine New Scientist published a survey gauging
the dependence of randomly selected U.S. patients’ groups on drug
manufacturers. Combing through the tax returns, annual reports and
voluntary disclosures of 29 nonprofit patient-advocacy groups, the
publication found that most accepted financial backing by companies
developing or producing drugs used to treat patients supported by the
group. In some groups, such as the American Heart Assn., the drug
makers’ financial backing was huge ($23 million in 2005) but
represented a small portion (4%) of revenue. For seven groups,
donations from interested drug companies represented more than
one-fifth of revenue. The Depression and Bipolar Support Alliance said
it received more than half of its 2005 funding from the drug industry,
and the Colorectal Cancer Coalition got 81% of its funding from drug
makers.
New Scientist’s probe found that some donations appeared directly tied
to marketing interests. In 2003 and 2004, when the drug giant Pfizer
was developing a drug to treat restless leg syndrome, it was a major
donor to the Restless Legs Syndrome Foundation. But in 2005, after
Pfizer announced it had abandoned development of the potential drug,
its donations to the patient group dried up.
Many of the best-known groups, including the Alzheimer’s Assn.,
American Cancer Society and American Diabetes Assn., typically have a
board of physicians who vet the scientific accuracy of the information
they provide to patients. And most solicit “unrestricted” grants that
allow them freedom to use the drug makers’ donations as they see fit.
But even large groups often provide a gateway to the products of
corporate sponsors, say those who have surveyed them. Many list
FDA-approved medicines available to treat the disorder that is their
focus and provide Web links that lead patients directly to marketing
sites. And many offer their corporate sponsors access to their
members, a potential gold mine of direct-marketing opportunity.
The corporate-donor pitch posted on the website of the national
infertility patient group, Resolve, is typical of many patient groups.
“Whether you become a site sponsor, a resource partner, or a sponsor
of Resolve’s chats, [the group’s website] is the ideal place for your
company to market its products and services to thousands of men and
women across the country,” the appeal states. Among the benefits the
group lists for becoming a member of the group’s “Corporate Council”
are access to data on utilization of the group’s programs and services
and “the opportunity to establish topics and sponsor special briefings
for patients, the medical community and public policy makers.” Serono
and Organon, both makers of prescription medication used to treat
infertility, are among the group’s corporate sponsors.
Patient groups also mobilize patients — sometimes armies of them –
to push for coverage of prescription drugs by insurance companies and
states’ Medicare and Medicaid agencies. To pharmaceutical companies,
this can make or break the market prospects for a new drug because 80
million Americans — among them, the heaviest prescription-drug users
– receive healthcare coverage through Medicare and Medicaid, and
roughly 155 million have prescription drug coverage through private
insurance companies.
Strength in numbers
WHEN insurers balk at reimbursing patients for new prescription
medications, these groups typically swing into action, rallying
sufferers to appear before public and consumer panels, contact
lawmakers, and provide media outlets a human face to attach to a
cause. Infertility patients mobilized by Resolve, for instance, have
been extremely effective in extending states’ insurance coverage of
infertility treatments. Groups such as the Depression and Bipolar
Support Alliance have fielded experts and patients who have done the
same for psychiatric conditions. And a wide range of patient groups,
most with substantial backing from the makers of erectile dysfunction
drugs, have mounted successful campaigns to get wary insurers to cover
drugs such as Levitra, Viagra and Cialis.