Drug marketing: OxyContin ads called misleading

During its extensive marketing campaign for OxyContin, Purdue Pharma sent doctors promotional videos that minimized the drug's risks and made unsubstantiated claims, according to a new federal report.

The General Accounting Office report also said the Food and Drug Administration had sent two letters to Purdue Pharma addressing what the agency said were misleading advertisements in JAMA and American Medical News. And the Drug Enforcement Administration said the pain drug was promoted to doctors who may not have been adequately trained in pain management.

Some physicians say they were misled about OxyContin's risks. They said the drug's marketing campaign and its fallout should serve as a warning to physicians to be more critical of promotional materials and to be sure to seek out other resources for reliable information on a drug's risks and benefits to patients.

"Physicians were duped. Purdue misled people either directly or indirectly, and they were called to task by several agencies," said Steven Blum, MD, director of the North Shore Pain Center in Skokie, Ill. "The abuse of [OxyContin] was never addressed."

But some medical leaders said physicians bear some responsibility if they accept a drug company's promotional material without verifying it with other resources.

"For anyone to listen to one source, that's just a big potential for trouble, whether it's for OxyContin or an antibiotic," said Michael Fleming, MD, president of the American Academy of Family Physicians.

Medical leaders said physicians know they should consult the Physicians' Desk Reference, peer-reviewed journals and other sources. But some doctors may not be as thorough as they should be because of time constraints and other pressures associated with practicing medicine in the current health care environment.

B. Elliot Cole, MD, said doctors should know everything they can about a medication, but adds, "I'm afraid, sadly, that happens too little."

Physicians should learn all they can about a drug being marketed to them and calculate the benefits and risks to patients before prescribing the medication, said Dr. Cole, director of education for the American Academy of Pain Management.

The relationship between physicians and drug salespeople already has come under scrutiny, and some groups have taken steps to provide guidance on the relationship.

In 1990, the AMA issued ethical guidelines regarding gifts to physicians by drug reps. In July 2002, the Pharmaceutical Research and Manufacturers of America issued voluntary principles on how drug companies should market and promote drugs to health care professionals. In April 2003, the U.S. Office of the Inspector General released guidelines for companies' interaction with health care professionals in connection with federal health care programs. But such efforts didn't keep congressional leaders from pursuing an inquiry into the marketing and abuse of OxyContin. The resulting GAO report, released in January, did not link Purdue Pharma's promotional efforts to abuse or diversion of the drug.

Purdue Pharma spokesman Jim Heins said the report was fair and balanced. "We've done extensive marketing, sure, but we have not done inappropriate marketing," he said. "Everyone agrees that doctors need more information on pain management, and that's what we were providing."

Some docs say no to videos

But there's one marketing tool doctors said drug reps should skip: promotional videos.

"I've got to see patients. I don't have time to see a video," said Steven M. Lobel, MD, who practices pain medicine in Chesapeake, Va.

Dr. Blum agreed. He said he turns to a pharmacologist for input on drugs, as well as studies and other resources. The Illinois anesthesiologist said it would be nice to have a national drug reporting center, run by a professional medical organization, with reliable information.

But Greenville, N.C. endocrinologist Mark Warren, MD, said information he gets from drug reps usually is on target. Dr. Warren reviews the material critically, reads package inserts and consults published studies and peer-reviewed journals.

Many physicians said they do the same, saying it's best to use multiple resources when considering a drug.

"There's never just once source of information available," said Greg Guzley, MD, a San Antonio oncologist who uses reliable Web sites and e-mail services for medical articles.

"I have two file cabinets at home that are just loaded with [medical] papers."