Unintended direct conflict between pharmaceutical marketing and public health
Medical ethicists examine aggressive marketing tactics’ influence on medical practice and outline strategies to protect patients
Drugs that pharmaceutical companies market most aggressively to physicians and patients tend to offer less benefit and more harm to most patients – a phenomenon described as the “inverse benefit law” in a paper from the University of Texas Medical Branch at Galveston.
Published online Thursday, Jan. 13 in the American Journal of Public Health, the article explores recent withdrawals of blockbuster drugs due to safety concerns and finds a clear pattern of physician-focused marketing tactics that ultimately exposed patients to a worsening benefit-to-harm ratio. Potential patient safety and public health implications include unnecessary exposure to adverse side effects, high medical costs and competition for scarce resources.
“This is not a random occurrence, but rather a repeating, planned scenario in which drugs, discovered with good science for a specific set of patients, are marketed to a larger population as necessary, beneficial and safer than other alternatives,” said co-author Dr. Howard Brody, a professor and director of the Institute for the Medical Humanities at UTMB Health. “Marketers are just doing their jobs. However, the reality is that for most new drugs, safety and efficacy are scientifically proven for only a small subset of patients. It’s time for physicians to take a stand and not prescribe them so readily.”
Macrolides Mixed With BP Drugs Can Lead to Hypotension
Simultaneous use of calcium-channel blockers and some macrolide antibiotics may result in hypotension, which may require hospital admission, according to a study published online Jan. 17 in CMAJ, the journal of the Canadian Medical Association.
MONDAY, Jan. 17 (HealthDay News) — Simultaneous use of calcium-channel blockers and some macrolide antibiotics may result in hypotension, which may require hospital admission, according to a study published online Jan. 17 in CMAJ, the journal of the Canadian Medical Association.
Alissa J. Wright, M.D., from the University of Toronto, and colleagues conducted a population-based study involving patients aged 66 and older who were prescribed a calcium-channel blocker between 1994 and 2009. The investigators identified which of the patients had been hospitalized for low blood pressure and whether they had been prescribed a macrolide antibiotic shortly before their admission.
The investigators identified 7,100 patients who were hospitalized with hypotension during treatment with a channel-blocker, of whom 176 had been prescribed a macrolide antibiotic. Erythromycin and clarithromycin were associated with hypotension (odds ratios, 5.8 and 3.7, respectively). Azithromycin was not associated with an increased risk of hypotension.
“Clinicians should be aware of the potential interaction between these drugs. When a macrolide is required, preferential use of azithromycin should be considered in patients already receiving a calcium-channel blocker,” the authors write.
Two of the study authors disclosed financial ties with pharmaceutical companies.