Sunday, August 01, 2004

An article in the June 22 Independent Record contained useful information about an important disease, Hepatitis C. Unfortunately, it also perpetuated several myths. I would like to give another perspective on Hepatitis C, its treatment, the need for "informed consent" in discussing treatment options with patients, and why the makers of Hepatitis C drugs have discouraged such discussion.

I'll give examples of how unethical financial incentives are used to encourage treatment of all Hepatitis C patients and explain why I believe pharmaceutical marketing and a distorted profit motive do not serve patients or the public.

Myths: The most misleading statement in the article is attributed to Dr. Dan Phillips, an Oregon physician whose Helena presentation was sponsored by Schering Plough, the maker of Hepatitis C medications. Dr. Phillips called Hepatitis C a "preventable terminal illness." The implication was clear: get treated or die! In fact, Hepatitis C results in death or liver failure leading to transplantation in only 10 percent of patients. In other words, nine out of 10 Hepatitis C patients will not die of their disease. In my practice, it is a rare patient who understands this fact when they first come for consultation. However, it's very important that they do understand because many of them cannot tolerate the medications and cannot receive treatment or simply do not need treatment. Also, almost half of the patients treated for the disease will not have a successful response. Those patients need to know that they have a serious disease but that MOST who have had no treatment or unsuccessful treatment for Hepatitis C will live out a normal life span.In the IR article and most information provided in lay publications there is the implication that treating Hepatitis C with medication is the most important aspect of their health care. No perspective is given. Many other aspects of a person's health care are more important. Two specific examples:

— Stopping alcohol consumption is critical. Frankly, if I had to choose between treating a patient with medication and stopping excessive alcohol intake, I'd choose the latter and the patient would have a better chance of improving her health.

— Smoking a pack of cigarettes daily for 25 or 30 years (the time it takes for Hepatitis C to cause serious problems) represents a far greater risk to a person's health than does untreated Hepatitis C.

Neither of these examples lessens the seriousness of Hepatitis C, but they do help put the disease in perspective. Informing patients of these important facts allows them to make an informed decision about whether to go forward with treatment.

Pharmaceutical industry practices: Recent revelations of unethical practice by pharmaceutical companies underscore the need for a careful understanding of the pros and cons of drug treatment. The New York Times (6/27/04) recently reported that Schering Plough is under federal and state investigation for payments made to providers to encourage them to treat patients with Hepatitis C. This offer was extended to me a couple of years ago and rejected. For filling out a few simple forms three times a year, I would have been paid $2,000 for each Hepatitis C patient I treated. Drug companies can offer such inducements because treatment costs more than $25,000 per year. There's still a lot of profit left after a clear conflict of interest payment is made.

Marketing: The media is saturated with ads for prescription drugs, which exaggerate benefits and minimize risks. As a result, expensive allergy medications outsell equally effective and far less expensive over-the-counter remedies. Four-dollar-a-day pills are used to treat minor heartburn on the erroneous assumption that this symptom is commonly associated with serious disease. Does this make any sense? Only if greed is driving the marketing program of an industry now spending three times as much on marketing as what it spends on research!

So what should you do if you have Hepatitis C? First, find a qualified primary care provider whom you trust. When necessary, seek appropriate consultation in collaboration with that provider. Do research on your own, either online or at the library. Ask questions. Don't be intimidated by lists of side effects but be sure that the potential benefits of a medication outweigh its risks. Finally, regard the claims of pharmaceuticals in the same light you would regard those that glamorize cigarettes and tout the "sex appeal" of Coors Light.

KEN EDEN is a Helena physician.