[Ip-health] Australia: Drug firms fund disease awareness

[Robert Weissman]

http://www.smh.com.au/articles/2003/12/12/1071125652945.html
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 companies.

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
http://www.smh.com.au/articles/2003/12/12/1071125656516.html

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 Minchin.
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 you

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 success.

"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 businesses".

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 Servier.

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 interest.

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 products.

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.

HORMONE REPLACEMENT THERAPY

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.