The dramatic increase in the usage of three anti-anemia medications to treat cancer and kidney patients is an excellent example of the many problems with the American pharmaceutical industry. The medications have achieved blockbuster status as a result of generous payments to physicians and rash promotional ads allowed by lax regulators. We now know that the typical injection or intravenous dosage levels used in medical offices and dialysis facilities may be detrimental to patients.
As Alex Berenson and Andrew Pollack revealed in The Times on May 9, the two corporations’ hundreds of millions of dollars in so-called rebates have fueled widespread usage of the medications, Aranesp and Epogen from Amgen; and Procrit from Johnson & Johnson. Typically, doctors buy the drugs from the manufacturers, then receive reimbursement for the majority of the cost from Medicare and private insurers. On top of that, they also receive these rebates based on the quantity of drugs they have purchased.
Although many doctors lament that they barely break even or even lose money on the expensive drugs, the rewards can be significant for high-volume providers. A huge chain of dialysis facilities receives an estimated 25% of its income and a higher percentage of its earnings from the anemia medications, while a group of six cancer specialists in the Pacific Northwest made a profit of roughly $1.8 million last year thanks to Amgen rebates. These financial incentives appear to have encouraged wider use and larger doses than are medically recommended.
While there is some evidence that high doses of the medications can be harmful, there is little proof that they are particularly effective in treating mild cases of anemia. In this nation, half of the dialysis patients are currently taking an amount of medication that causes the Food and Drug Administration to consider their red blood cell counts to be at dangerous levels. The F.D.A. was urged last week to impose more restrictions on the use of the pharmaceuticals in cancer chemotherapy patients based on studies suggesting that the treatments may worsen some tumors or expedite patient deaths.
Television advertisements that promote the use of Procrit claim that it gives elderly cancer patients greater energy and, by emotionally upsetting them, enables them to keep up with their grandchildren. The F.D.A. does not believe that allegation has been proven, and a top official stated last week that his organization owes the public a good justification for why it permitted the commercials to run.
Hopefully, the advisory panel’s worries will make many oncologists rethink prescribing the anti-anemia medications. But ceasing rebates is the most reliable strategy to reduce overprescribing. Drug corporations are already prohibited by federal law from paying physicians to write prescriptions for pills. The same rule ought to apply to intravenous and intramuscular medications.