Found this on stockhouse..
With Vioxx gone, now what do I do?
Conflicting commercials are driving patients into their doctors' offices for advice
By Christopher Rowland, Globe Staff | November 7, 2004
Drug companies rushing to fill the vacuum left by Merck & Co.'s withdrawal of its best-selling arthritis drug Vioxx are flooding the airwaves with competing advertising claims that are bewildering many patients.
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Over-the-counter pain-relief competitors like Advil, Aleve, and Tylenol have turned up the volume on TV, radio, and in print advertising that speaks directly to Vioxx fears in an attempt to grab a larger slice of the market. Pfizer Inc., the maker of two competing prescription drugs that are in the same class as Vioxx -- Celebrex and Bextra -- also has launched a big ad campaign. Pfizer is avoiding any specific reference to Vioxx while combating fears among patients and doctors that its drugs may cause similar problems to Vioxx.
The blitz of conflicting ads can be overwhelming to many of the 20 million former Vioxx users forced to switch, and many other arthritis sufferers who are wondering what to do, doctors say.
"It adds to their confusion. Patients feel anxious," said Dr. Eileen Winston, a rheumatologist in Framingham who is one of many doctors who say they are spending significant amounts of time explaining alternatives to scared patients. To save time, Winston said, she has resorted to addressing groups of patients in her waiting room about the pros and cons of competing treatments.
Among Winston's patients is 68-year-old Mary Allen of Marlborough, who said she was taking Celebrex for a swollen, painful knee, and it worked. "When I heard about this Vioxx scare, I just took myself right off it," she said. "Now, I don't know what I will take."
She has begun exploring alternative therapies, including an herbal concoction she ordered from Australia. She is also considering acupuncture.
Merck threw the market for arthritis pain drugs into chaos when it voluntarily removed Vioxx from circulation. Vioxx belonged to a class of drugs called Cox-2 inhibitors. Cox-2s were widely embraced after their introduction in the 1990s as powerful pain relievers without the potential gastrointestinal side effects of traditional pain remedies.
But after fending off warnings for years, Merck said one of its own clinical trials showed the drug elevated patients' risk of stroke and heart attack.
Merck's action raised fears about the Cox-2s, Celebrex and Bextra. These drugs remain on the market in the absence of any evidence linking them to heart attacks and strokes. Pfizer is even seeking to strengthen its Celebrex brand with a fresh round of television and print advertising. A print ad shows a cartoon character swatting a tennis ball after treating an inflamed elbow with the drug and says, "Over-the-counter pills may not always be what you need."
Pfizer said the new campaign was under development for months, well before the Vioxx flameout. The advertisements are meant to encourage Americans to see their doctor, said Pfizer spokeswoman Michal Fishman. "It's really about making sure that people have the motivation to talk to their doctor, now more than ever," she said.
he company also said it will launch a clinical trial involving 4,000 patients next year that will test whether Celebrex actually helps prevent heart attacks and strokes. Results are supposed to be available in 2007.
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Meanwhile, at least three competing and less expensive over-the-counter drugs, Advil, Aleve, and Tylenol, are directly trying to fill the Vioxx gap, too. A new ad slogan for Tylenol Arthritis Pain Extended Relief, marketed by a division of Johnson & Johnson, sums up the approach: "Don't let the recent news about your arthritis medicine stop you from treating your arthritis pain."
"They are all playing off this safety issue right now," said Thani Jambulingam, chairman of the pharmaceutical marketing program at Saint Joseph's University in Philadelphia.
In another marketing twist, TAP Pharmaceutical Products Inc. is offering consumers a free, seven-day supply of NapraPAC, a package that includes a prescription Naprosyn pain pill (with the same active ingredient as Aleve) alongside a tablet of prescription Prevacid antacid to ward off stomach damage.
"Arthritis pain relief your stomach can live with," says the NapraPAC website.
Several rheumatologists said the Vioxx withdrawal is a good lesson that just because a drug is heavily advertised and prescribed does not make it a good choice.
"Merck had done us a wonderful service," said Dr. Anne Sigsbee, a rheumatologist affiliated with Cape Cod Healthcare. "This makes it easier when people come in clutching a print ad or talking about a television ad, saying 'Isn't it great?' We can now allude to this moment and say, 'Just because it's advertised doesn't make it good.' "
Sigsbee and other doctors said that the Vioxx withdrawal also presents an opportunity for a pain-relief reality check.
"This is a good time for doctors and patients to re-explore why you are taking these medications in the first place," said Dr. Don Goldenberg, chief of rheumatology at Newton-Wellesley Hospital.
Goldenberg's office telephoned 350 patients in the days after the Vioxx withdrawal and advised them to switch to another form of pain relief.
Goldenberg said he wrote new prescriptions for Celebrex for some patients, while some others came into the office for more in-depth consultations.
Goldenberg is among doctors who believe all Cox-2 inhibitors carry some cardiovascular risk, despite assertions from Pfizer that Celebrex and Bextra are fine. But he said the risks can be minimized by limiting its use to patients whose cardiovascular systems are strong.
Several stock analysts who follow drug companies said physicians will switch patients to Celebrex in the short term.
"Celebrex is picking up some of the slack, but the whole Cox-2 market can be expected to continue to shrink," said Viren Mehta, managing member of Mehta Partners LLC in New York. "The concerns about side effects are real and intense."
Down the road, he predicted, doctors and patients will return in larger numbers to the tried-and-true over-the-counter medications.
"Marketing hype has been successful in creating extraordinary demand for the Cox-2 class," said Mehta.
But Donna Allen, a 50-year-old technology recruiter from Berlin, Mass. (and no relation to Mary Allen), said she is sticking with Celebrex as long as she can.
She said it takes care of the debilitating symptoms of her rheumatoid arthritis, which make daily tasks like turning a doorknob or her car's ignition key a painful ordeal.
"You worry about damage to your cardiovascular system every time you eat a cheeseburger, too," she said. "In the meantime, I'm pain free."
Christopher Rowland can be reached at crowland@globe.com.
© Copyright 2004 Globe Newspaper Company. |
