Drugs are Losing the Battle Against Heart Disease. Here's Why.

Drugs are Losing the Battle Against Heart Disease. Here's Why.

The percentage of the U.S. population taking at least one prescription drug during the past 30 days increased from 38% in 1988–1994 to 48% in 2005–2008. During the same period, the percentage taking three or more prescription drugs nearly doubled, from 11% to 21%, and the percentage taking five or more drugs increased from 4% to 11%. These data come from the CDC "Health, Unites States, 2011" report (find it here).

Meanwhile, the prevalence of heart disease, which is the leading cause of death in the U.S., remained steady from 1999–2000 to 2009–2010 among adult women in all age groups, and among men 45–74 years of age. Among men 75 years of age and over, prevalence rose from 39% in 1999–2000 to 45% in 2009–2010.

There goes my rationale for taking statins to lower my risk of heart attack! It seems that the drug industry is not as successful in improving our health as it claims to be.

And new drugs aimed at lowering the risk for heart disease currently being developed may be effective in achieving "surrogate endpoints" in clinical trials but not effective in reducing risk.

That was the takeaway from a new study published online recently in The Lancet. That study provided evidence that increasing the level of HDL ("good cholesterol") does not lead to less risk for heart disease (see "HDL hypothesis is on the ropes right now").

That's not good news for companies that are actively developing and testing drugs that raise HDL -- even if these drugs succeed in that goal they are not likely to help prevent heart disease.

There's lots of other interesting data in the CDC report. I've gathered my favorite charts into the infographic shown here (click here for an enlarged view).

AstraZeneca's Timely CRESTOR Branded Blog Post: Did It Violate Its Own Policy?

AstraZeneca's Timely CRESTOR Branded Blog Post: Did It Violate Its Own Policy?

It's unusual for a pharmaceutical company to mention a product by brand name on its corporate blog. It's even more unusual to mention BOTH the product AND its indication -- because that would be promotion regulated by the FDA. But AstraZeneca (AZ) has done just that on its "AZ Health Connections" corporate blog.

The majority of the post "New CDC data shows drop in number of adults with high cholesterol" submitted by Tom Hushen, AZ's External Communications Manager, talks about CRESTOR, AZ's anti-cholesterol drug. The post may have been ghostwritten for "Dr Philip de Vane, Executive Director of Clinical Development at AstraZeneca," whose name appears at the bottom.

After briefly citing the results of the CDC (Centers for Disease Control) study (see below) in the first paragraph, Hushen dedicates the most of the remaining 309 words of the 377-word post to CRESTOR as in:

"AstraZeneca applauds this progress and we are proud that when diet and exercise alone aren’t enough, prescription medications like CRESTOR® (rosuvastatin calcium) are able to help patients reach their cholesterol goals. In adults, CRESTOR is prescribed along with diet to lower high cholesterol and to slow the buildup of plaque in arteries."

Included in the post is the "fair balance" information required by law:

"CRESTOR is not right for everyone─like people with liver disease or women who are nursing, pregnant or may become pregnant. Tell your doctor about other medicines you are taking. Call your doctor right away if you have muscle pain or weakness; feel unusually tired; have loss of appetite, upper belly pain, dark urine, or yellowing of skin or eyes─these could be signs of rare but serious side effects. See www.CRESTOR.com"

Although this is not earth-shaking or in violation of any law that I know of, it nevertheless is the FIRST time a pharmaceutical company has promoted a prescription drug on its official corporate blog -- ie, talked about the drug's benefits.

It's even more interesting considering the AZ Health Connections "Comment Policy" seems to preclude any comments about specific products:

"We want to make sure AZ Health Connections provides a good experience for all visitors. Therefore, we want to keep the content focused on the specific topics being addressed. Comments that don’t directly relate to AstraZeneca or the topics currently being discussed, or comments or questions about specific products (whether or not AstraZeneca products) or ongoing legal or regulatory matters may not be published or may be removed."

Could it be that what's good for the "goose" (AZ) is not good for the "gander" (everyone else)? It seems that AZ has relaxed its comments policy, at least this one time. As proof of this, I submitted the following comment, which AZ published:

"I am one of those U.S. adults with high cholesterol that is having problems controlling it with just diet and exercise, which I don’t even try to do :-). But I am worried about taking powerful medicines such as CRESTOR because of the side effects that you mention."

AZ published that comment made by this "gander." It is the only comment published so far, so I have no idea if other people have submitted comments that were NOT published. Maybe Tony Jewell, Senior Director of External Communications at AstraZeneca US, will tell us. NOTE: Jewell received the coveted "Pharmaguy Social Media Pioneer Award" in 2011 (see here).

Note: In a personal email, Jewell said: "This post was reviewed, as are all others that mention medicines or disease states. There have been many on the blog, Twitter and Facebook." Upon searching the AZ blog site for other posts that mention CRESTOR, I could not find any post that mentioned the product name AND the disease state (high cholesterol) it is approved to treat. There were, however, a couple of posts that mentioned CRESTOR without its indication. 

Why did AZ do this at this time? It seems to be very opportunistic considering that it coincides with the release of CDC data that shows improvement to cholesterol levels for many Americans. Also, Pfizer just announced it is no longer promoting Lipitor (see "Pfizer Throws In the Lipitor Marketing Towel" and "Lipitor R.I.P. Infographic").

Obviously, now is a good time for AZ to ramp up the promotion of CRESTOR, as it is positioned to take over the number one (or virtually ONLY) statin TOP sales spot (see chart below):

It's also obvious that AZ wants to take some credit for the results reported by the CDC, which are summarized in the following "infographic" (creating infographics is a new obsession of mine):

Some interesting conclusions can be made from the data in this CDC report, which you can find here.

For one thing, women are not doing as well as men in terms of lowering their total cholesterol. This is especially true for women aged 60 and over. Women in that age group have consistently higher percentages of high total cholesterol than men.

The percentage of adults with low HDL cholesterol was higher for men (31.4%) than for women (11.9%).

Although the CDC does study the use of statin drugs by adults and breaks this down by sex and age (see top chart in the infographic), the CDC's analysis that is highlighted in AZ's blog post is based "only on measured cholesterol and does not take into account whether medications are taken."

That's too bad. It would have been interesting to see the correlation between statin use and lowered measured cholesterol.

More important than managing cholesterol levels, however, is whether or not statins actually improve health outcomes such as heart disease. There are results from clinical trials that indicate such a benefit, but how does that correlate with results in the real world?

Just curious.

Antidepressants: Top Advertised & 3rd Most Commonly Used Rx Drug

Antidepressants: Top Advertised & 3rd Most Commonly Used Rx Drug

According to a recent CDC Data Brief (find it here), antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%.

Key findings (2005–2008):

• Eleven percent of Americans aged 12 years and over take antidepressant medication.
• Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are nonHispanic black and MexicanAmerican persons.
• About one-third of persons with severe depressive symptoms take antidepressant medication.
• More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
• Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year

Here's a chart that breaks it down by age group and males vs. females:

Click the image for an enlarged view

Perhaps not so coincidentally, antidepressants are among the TOP advertised Rx category in 2010, according to the recent AdAge analysis I summarized in a previous post (see "Double Dip in DTC Spending Plus 33% Drop in Internet Display Ad Spending!" and pie chart below). 

Of the TOP 25 advertised drugs in 2010, DTC ad spends for antidepressants was 20% of the total (24% if you include Lyrica, which is not indicated for depression but is often prescribed for depression off-label).


The CDC data covers the time period 2005-2008, which is somewhat prior to when the full effects of the recession were felt by the recently unemployed. 


Women are twice as likely to take anti-depressants than men (Overall, 40% of females and 20% of males with severe depressive symptoms take antidepressant medication says CDC). Actually, for all degrees of symptoms, women are 2,5 times more likely to take antidepressants than men (see data in chart above).


Why are proportionately more women taking antidepressants than men? The CDC News brief doesn't say, but news reporters have suggested that more women are caregivers and therefore subject to depression linked to that.


Or could it be the DTC advertising of antidepressants that lead more women to ask their doctors about antidepressants (see, for example, "Women Need More Love, Less Drugs")?


Actually, practically every DTC ad (except ads for Viagra) "speaks" to women -- the ads most often focus on the woman as the sufferer of the indicated condition or the caregiver. 


This is part of an issue that I will discuss with several experts in an upcoming LIVE podcast titled "How to Score With Women (as a Marketer) via Social Media." One question I'd like to ask the experts is this: Do pharma marketers focus on women because they are the majority of the audience or because they buy more products (including drugs) than men (ie, are more prolific consumers than are men)? I tend to favor the latter over the former. What do you think?

Tracking Public Health Trends: Twitter vs Google vs Your Nose

Tracking Public Health Trends: Twitter vs Google vs Your Nose

While my son was away at school this spring, I asked him how he was doing. "OK dad," he said, "but I have this cough the last few days." I didn't have to search Google or call our physician or tweet about it to learn what may be the underlying problem. I only had to use my nose to know it was allergy season. Given my son's history, I surmised that was the root cause of his problem.

But public health officials cannot depend upon their noses to make important decisions. They need actionable real time data. How do they get it?

The Centers for Disease Control (CDC) offers the most dependable disease surveillance data. The system depends on reports from partners in state, local, and territorial health departments, public health and clinical laboratories, vital statistics offices, healthcare providers, clinics, and emergency departments. I imagine a lot of paperwork and time are involved.

Some time ago, Google decided that search trends can be used to track diseases such as influenza. It published results of a study of its data in a white paper: "Detecting influenza epidemics using search engine query data" (find it here). They found a strong correlation between search data and CDC data as shown in the chart below:

Now, researchers at the Johns Hopkins Center for Language and Speech Processing have analyzed 2 billion public tweets posted between May 2009 and October 2010 to learn if it is possible to use Twitter to track important public health trends (see "Analyzing Twitter for Public Health").

The researchers point out the differences between search and Twitter (or other social media) with regard to the intent of the user. "In web search," says Mark Dredze (one of the researchers; see a video of his presentation of results here), "the user expresses a need for information. Whereas in social media, people actually say something about themselves." In that sense, it's easier to conclude that the Twitter poster actually has the flu, whereas the searcher may or may not.

Another advantage of Twitter is that people disclose a lot of information about themselves that can add value to the public health data. This includes information about the drugs they may be taking. That information, of course, is of interest to pharmaceutical companies.

Here are the results from the Johns Hopkins study, which analyzed 1.5 million messages (out of 2 billion total collected) that referred to health matters:

Pharmaceutical companies -- and the FDA (see "FDA is Monitoring This Blog and Perhaps You Too!") -- are already mining social media to learn what the public is saying about them, their products, and their competitors' products (see "Are J&J Agents Trolling for Adverse Events on the Internet?"). But I suspect the technology they are using is relatively primitive compared to that used by the Johns Hopkins researchers.

Alex Butler posed a question during yesterday's #hcsmeu chat: "Have we been concentrating too much on SM as pure communication and not enough on impact of 'big data' to revolutionise health care?" This lead to a lively discussion on the value of "crowdsourcing" to somehow change healthcare. For more on that topic, see "Data Mining in the Deep, Dark Social Networks of Patients."

I can see the value of social media to do surveillance as was done in the studies mentioned above. Such surveillance certainly helps public health officials deal with certain diseases and other health issues (ie, obesity). But it doesn't change the fundamental problem of health care, which is the cost burden. To truly "revolutionise" healthcare -- IMHO -- you have to lower costs and make even rudimentary health care affordable for EVERYONE. But that's a matter for another post!

[This post originally appeared in Pharma Marketing Blog. 

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