Opinion: Lethal marketing

POSTED: 07/16/12 11:33 AM

When general practitioners start warning about the safety and effectiveness of prescription medication it’s time to pay attention. Hans van der Linde, a Dutch general practitioner wondered in a column in the Volkskrant why millions of people are taking a lot of medication of which the long term effectiveness and safety lack all proof. This is his story.
GlaxoSmithKline pays $3 billion for criminal sales practices, a headline in the Volkskrant of July 4 read. It was not the first ransom. The blood-sugar level lowering remedy Avandia had cost thousands of lives. GlaxoSmithKline remained silent about the product’s side effects and in 2010 it was taken off the market. The behavior of other pill-producers is not much better. The pharmaceutical industry has a reputation of a ruthless hunger for profit – and that is entirely justified. The question remains whether there are others to blame as well.
In these scandals the role of governments and doctors remains strongly underexposed. Governments are responsible for admitting pharmaceuticals onto the market and doctors are responsible for prescribing them. There is a lot wrong with this and we are not learning from it. What causes that people are insufficiently protected against lethal marketing practices? The answer is that all these scandals stem from the admission of pharmaceuticals without proof of long term safety and effectiveness, and that doctors are not sufficiently aware of this.
It is always about new, patented and expensive pharmaceuticals. Those lucrative remedies have to get “in doctors’ pens” as soon as possible because the patent expires after fifteen years. We never know the long term safety and effectiveness of new medicine. Only long-running research will provide the answers, but those are not mandatory. Intensive marketing makes sure that millions of people immediately start taking the remedy – and every time this leads to catastrophes. That is well-known but governments fail miserably in making the admission requirements stricter.
This is even truer for preventive medication. These pharmaceuticals are used by people that are fit as a fiddle because they have a risk factor like increased blood pressure or cholesterol and glucose levels that are deemed too high. It is an immense market because there are a lot of healthy people.
Producers of preventive medication do not have to prove that its users live longer to get it admitted onto the market. Lowering a risk factor is sufficient – unbelievable, but true.
Eraldin lowered blood pressure, Lipobay lowered cholesterol levels and Avandia lowered blood sugar levels. Within a short period of time millions of people took their remedies and tens of thousands died from their side effects. According to American investigative committees 47, 000 people died from using Avandia alone. An astonishing 80 percent of diabetics in America took Avandia. In the Netherlands the percentage was 8.
The remedy is clear. Do not prescribe new medication immediately to millions of people, but prove the long term safety and effectivity first. Unfortunately, most doctors trust that it will be okay. Governments have difficulties to get out of line with other countries, and patients’ minds are put at ease when for instance their blood pressure goes down.
In the meantime new scandals are emerging. The successors of Avandia for instance. Doctors are being indoctrinated with a lot of marketing pressure. There is no proof of the long term safety and effectiveness of these remedies, and the Dutch Association of General Practitioners advises not to prescribe them. But in the meantime internists continue to prescribe these pharmaceuticals.
People who take them should know that there is insufficient know-how about their side effects and that we do not know anything about their long term effectiveness. One could live longer but also shorter because of these remedies.
While this is obviously a concern expressed by a general practitioner in the Netherlands about the situation in that country, it is good to note that the pharmaceutical industry has a global reach and that there is a fat chance that these so-called preventive pharmaceuticals are also available and prescribed in St. Maarten. If the attitude of St. Maarten’ government and that of local general practitioners mirrors that of their colleagues in the Netherlands, the people who take these pharmaceuticals are left to their own devices. Taking a critical look at the contents of the medicine cupboard at home could easily save some people several years of their lives.

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