Conflicts of Interest and the Marketing of Requip

The Wall Street Journal recently reported (link requires subscription) on the marketing campaign by GlaxoSmithKline (GSK) to sell more Requip (ropinirole) for restless legs syndrome (RLS). Having seen far too many direct to consumer (DTC) advertisements on television about this disease, my first response was to groan, "not more about restless legs," but in fact the WSJl article was revealing. It also referred to an important scholarly article by Steven Woloshin and Lisa Schwartz in PLoS Medicine (Woloshin S, Schwartz LM. Giving legs to restless legs: a case study of how the media helped make people sick. PLoS Medicine 2006; 3(4): (e)170)

The Requip marketing campaign was very succesful. As the WSJ reported, "Requip is on track to post sales of $500 million this year, making it one of the fastest growing drugs in Glaxo's portfolio." Both articles focussed on how Requip was advertised directly to consumers, and how the media addressed the drug. However, I wanted to focus on how GSK employed conflicts of interest to market its product:

Conflicts of Interest Affecting Physicians - According to the WSJ, "Glaxo began its blitz by advertising the disorder to doctors in medical journals months before the company had regulatory approval to begin selling Requip for RLS. Then, it sent specialists to discuss the disease with general practitioners, who usually see RLS sufferers first." Furthermore, "soon after the FDA approved Requip as an RLS treatment in May 2005, Glaxo hired an army of sleep-disorder specialists and invited general practitioners to dinner at fancy restaurants across the U.S. to hear them speak about Requip, some specialists say. Philip Becker, medical director of the Sleep Medicine Institute at the Presbyterian Hospital of Dallas, says he has delivered about a dozen such talks in Texas. Dr. Becker, who has treated RLS for 25 years, says he thinks his talks have persuaded some doctors to take the disorder more seriously and to try Glaxo's drug."

Conflicts of Interest Affecting Disease Advocacy Not-for-Profit Organizations - According to the WSJ, "Awareness of the syndrome rose within months of Glaxo's first TV ads, says the Restless Legs Syndrome Foundation, in Rochester, Minn. It had about 2,600 visitors a day to its Web site before the Glaxo ad campaign. Two months later, about 4,500 people a day were visiting, says Georgianna Bell, executive director of the foundation." Even this WSJ article left something important out here. Woloshin and Schwartz wrote that one-fifth of the media articles they surveyed "referred readers to the 'nonprofit' Restless Legs Foundation for further information; none reported that the foundation is heavily subsidized by GlaxoSmithKline." The Foundation's 2005 annual report lists GSK as a "corporate gold partner," meaning that the company contributed at least $250,000. It is the only corporate partner listed, and the only donor making a contribution of more than $10,000 listed.

Reports of how commercial firms market health care products through apparently disinterested, respected intermediaries, like academic physicians and disease advocacy not-for-profit organizations, are becoming distressingly routine. For instance, we have recently discussed allegations about how Amgen supported the development of guidelines for the use of Epogen by the National Kidnesy Foundation (here), and how Eli Lilly marketed Xigris by providing grants to physicians and bioethicists to address rationing of health care (given that Lilly marketers apparently believed that Xigris was being rationed), and by supporting the Surviving Sepsis campaign and its development of relevant guidelines (here).

So I thought I would raise some questions about these marketing practices.

To physicians and academics paid by commercial marketers to give talks or write papers favorable to their products -

• Did you tell your audience that this was a marketing effort?
• Did you tell your audience that you were paid by to market the product?
• If not, were you being honest?
• How else would you describe your actions?
• Do you consider yourself a part-time marketer?
• If not, what would you call your role?
• Is being a part-time marketer in conflict with your values and mission?

To not-for-profit organization leaders paid by commercial firms to support their marketing efforts -

• Do you announce that you are funded by marketers to support marketing efforts?
• If not, are you being honest?
• How else would you describe your actions?
• Do you consider yourself a part-time marketer?
• If not, what would you call your role?
• Is being a part-time marketer in conflict with your organization's mission?

As we have discussed before, conflicts of interest cause people to fail to think clearly, or " people who have conflicts of interest often find giving clear advice (or opinions) particularly difficult" (see post here). Those with such conflicts, however, need to think particularly clearly about what they are really doing. And we all need to think about how Transparency International defines corruption (in the ethical, but not necessarily the legal sense) - "Corruption is operationally defined as the misuse of entrusted power for private gain."