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Alert Number 201

Epoetin: Money Makes the World Go Around

Date: November 16, 2006

Back in November of 2003 we published our first warning about excessive use of epoetin drugs, and the potential risk of increased cancer risk they pose. Here is the link to that article: The Dark Side of Epoetin.

In June of 2006 we reiterated the risk when additional information became available: The Dark side of Epo - Getting Darker.

It turns out we were right to caution patients about excessive use of anti-anemia growth factors. The wire services are full of the latest information on epoetin drugs (Epogen, Procrit and Aranesp), based on a new study to be published in the latest issue of the New England Journal of Medicine. Harvard Medical School researchers report in this article that using higher levels of hemoglobin as the desirable target in cancer patients and kidney dialysis patients, and therefore giving patients enough epo drugs to achieve these higher goals, exposes patients to 34% higher chance of dying from heart disease!

Patients in the USA receive far higher amounts of epo drugs than any place else. Mind you, this stuff is not cheap — we are talking of several thousands of dollars for each full course of treatment. So why do Americans get overdosed on these expensive drugs? Money makes the world go around, my friends. Just look (below) at the profits made by Amgen and Johnson & Johnson, the two drug companies that market epo drugs in America. I have watched with disbelief as slick TV commercials tout the ‘miraculous’ impact of epo drugs, a clear case of direct marketing of drugs to vulnerable patients. Sure, the commercial says at the end that patients should talk to their doctors. But which over-worked doctor is going to take the time to argue against prescribing more of the drug, when the patient has already been sold on it? No skin off his nose, and in any case insurance or Medicare will pay for it, right? Take more epo, and you will be happier, look better, be more successful at work, your grand-kids will love you more. The message is insidious, and it takes a strong person to resist its temptation. But the bottom line is this: every dollar spent on healthcare comes out of your pocket and mine, we pay insurance premiums and taxes and work for the employer contribution to our healthercare plans to pay for every single dime of healthcare expenses, no exceptions. None. And sometimes these drugs (and medical procedures) do more harm than good.

Believe it or not, it seems CLL Topics is becoming important as a trend setter and opinion maker in our little corner of the world. We get phone calls, letters and requests for direct meetings from drug companies and their representatives, all looking to get better reviews of their products on our website. PC and I get offers of all expenses paid trips to Bethesda, to campaign in favor of pharmaceutical companies as they face FDA scrutiny. We say "No thanks" to each and every one of them. When you judge the quality and impartiality of information on the internet, probably the most important criteria is to follow the money trail. People and organizations can be bought easier than you think: their income and employment may depend upon it. You can verify our scrupulous avoidance of such conflicts of interest by looking up our finances on our website: Notes on Fund-raising. Voluntary contributions from patients, their families and their caregivers are our only source of funds. And that policy will not change.

Be well,

Chaya
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News Report

International Herald Tribune

Bad news for top-selling anemia drugs

By Alex Berenson

The New York Times

A new medical study suggests that high doses of a best- selling drug used to treat anemia in dialysis and cancer patients may increase the risk of heart problems and death.

Each year, almost a million people in the United States receive prescriptions for the drug, known as epoetin, or for darbepoetin, a closely related drug also used in anemia treatment.

Worldwide, sales of the two drugs - sold under the brand names Epogen, Procrit and Aranesp - exceeded $9 billion in 2005 for Amgen and Johnson & Johnson, their makers.

In the first nine months of 2006, Amgen sold $4.9 billion worth of Aranesp and Epogen, accounting for almost half of its revenue.

Johnson & Johnson, which sells epoetin under the brand names Procrit in the United States and Eprex everywhere else, reported sales of $2.4 billion in the first nine months of 2006, down slightly from 2005.

Researchers for the study, which was to be published Thursday in the New England Journal of Medicine, split anemic patients with kidney disease into two groups. One group received epoetin with a goal of almost fully correcting their anemia, a lack of red blood cells associated with fatigue and shortness of breath.

The others were allowed to remain more anemic and generally received less epoetin. Patients in the first group were 34 percent more likely to die or suffer heart problems than those in the second group.

Dr. Ajay Singh, an associate professor at Harvard Medical School and the lead author of the study, said the results were surprising and should encourage doctors to treat anemia less aggressively.

The study tested anemia in kidney patients who did not yet need dialysis, a mechanical blood-filtering technique used to keep alive patients whose kidneys have almost entirely failed. But its findings should apply to patients on dialysis as well, Singh said.

The findings reinforce mounting concerns that kidney patients may be receiving too much epoetin, in part because dialysis clinics make bigger profits for providing larger doses. Studies show that the clinics make little, if any, profit on the actual dialysis services they provide for Medicare patients, who are the vast majority of patients.

The amount of epoetin received by the typical dialysis patient in the United States has nearly tripled since the early 1990s. The average patient now gets epoetin doses similar to those given to the first group in Singh's study.

About 22 percent of dialysis patients in the United States die every year, compared with about 15 percent in Europe.
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