Berndt's To Inform or Persuade-Direct-to-Consumer Advertising of Prescription Drugs

Berndt's To Inform or Persuade-Direct-to-Consumer Advertising of Prescription Drugs

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n engl j med 352;4 www.nejm.org january 27, 2005 325 PERSPECTIVE would not prevent further spread, but it might re- duce the shedding of the virus and would, in any event, be required for ethical reasons. All these ac- tions rely on early recognition through good sur- veillance and the ability to deliver the antiviral drug at a time when transmission might still be ineffi- cient. The logistic hurdles are formidable. A mobile stockpile of the drug would have to exist and be made available in the affected country. Oseltamivir is now being stockpiled by a number of developed countries for use once a pandemic virus becomes es- tablished and begins to spread rapidly around the globe. Developing a stockpile in an attempt to re- strict the spread of the new virus at its source might mean diverting drugs from other national stock- piles. However, this diversion must happen. The notion of trying to control a pandemic at its source would have been considered laughable just a few years ago — but that was before SARS transmis- sion was controlled by public health measures. We have no idea whether a type A (H5N1) virus that was fully adapted to humans would continue to be highly lethal, but it is nevertheless incumbent on the global community to try to contain it. The avian origin of previous pandemic viruses was recognized only after the fact; this time, we have been given a warning. We really are not sure when, or whether, the type A (H5N1) virus will start to spread among humans, but we must be ready to stop it if we can — and, if we cannot, at least to mit- igate its effects through the use of stockpiled anti- viral drugs and, eventually, strain-specific vaccine. Dr. Monto reports having received consultation fees and grant sup- port from Roche. 1. Li KS, Guan Y, Wang J, et al. Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. Nature 2004;430:209-13. 2. Govorkova EA, Leneva IA, Goloubeva OG, Bush K, Webster RG. Comparison of efficacies of RWJ-270201, zanamivir, and osel- tamivir against H5N1, H9N2, and other avian influenza viruses. Antimicrob Agents Chemother 2001;45:2723-32. 3. Monto AS. The role of antivirals in the control of influenza. Vaccine 2003;21:1796-800. Merck’s withdrawal of rofecoxib from the market last September and Pfizer’s announcement in De- cember of possible cardiac risks associated with high doses of celecoxib reignited long-simmering controversies regarding drug promotion, in part be- cause both cyclooxygenase-2 inhibitors have been heavily marketed directly to consumers. Indeed, af- ter discussion with the Food and Drug Adminis- tration (FDA), Pfizer suspended all direct-to-con- sumer advertising of celecoxib. Adding fuel to the fire is class-action litigation filed against Astra- Zeneca alleging that its direct-to-consumer adver- tising misrepresents the superiority of its proton- pump inhibitor esomeprazole over less expensive alternatives. Although the information made public in these
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Berndt's To Inform or Persuade-Direct-to-Consumer Advertising of Prescription Drugs

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