Jerome Bettis, the American Lung Association and GSK
Is this a sordid tale of a drug company buying off a non-profit and a football star or a happy tale of increased publicity for a disease leading to better care and more use of a specific medicine. I’m not sure. This isn’t the worst arrangement I’ve seen and no one seems to be acting unethically, but something about the whole deal still bothers me. So, I report, you decide (and unlike Fox I mean it).
Today’s Pittsburgh Post-Gazette health section has an article about Jerome Bettis and his asthma. Judging by this Google search you’ve probably seen him too, on TV or in your local media talking about his struggles with his asthma, how he couldn’t breathe during a Monday Night Football game and how know his asthma is under much better control. He also never fails to mention the “Asthma Control Test” which is being pushed hard by the American Lung Association (ALA), backed by big funding (>$10M, I think) from GlaxoSmithKline (GSK). To his credit, he doesn’t mention GSK or any specific product in the spots I’ve seen.
Is GSK promoting the test just to make the world a better place? Don’t bet on it. GSK’s Flovent (generic: fluticasone), the leading inhaled corticosteroid and mainstay of many asthmaticss daily treatment regimen went off patent in May, 2004. Aarently, there have been some delays getting generic products to market with the move from CFC to HFA propellants (related to global warming, although I doubt inhalers play a substantial role) and such.
But Advair (the combination of fluticasone and salmeterol, a long acting beta agonist) for patients with more serious asthma is doing well and has many years (at least 2010 in the US). What’s more Advair is the only ICS/LABA (inhaled corticosteroid/long acting beta agnosist) on the market in the US. AstraZeneca’s Symbicort (budesonide/fomoterol), which is probably a better med, is stuck at the FDA and the drug reps tell me it will be 18 months before it is available. Given that for 2 years they’ve been saying 12 months that is bad news. It is available in Europe and Canada.
Naturally, GSK would love for more people to take Advair. And it is a great medicine. If every asthmatic got optimal treatment, Advair sales would go sky high.
So how about the test? Well it is pretty good. I went through and put in the values I’d consider acceptable for one of my patients with asthma (no limitation of activities, short of breath and albuterol use 1-2x/week, nocturnal cough 1-2x/month and overall feeling the asthma is well-controlled*) and got a score of 20, which the test interpreted as good control. But any increase in symptoms and you are at 19, which means you should see your doctor, which is perhaps a bit strict but not unreasonable.
So GSK is funding the ALA and perhaps paying Jerome Bettis (I don’t think he is doing this for free, but can’t find a link to him being paid by GSK) to go around and get tons of free publicity for asthma in general and the Asthma Control Test in specific. GSK hopes more people visiting their doctor will result in more Advair being prescribed.
Is this wrong? Well, it is certainly not horrible. GSK is in the position where better treatment of asthma will help it make more money (and asthma in the US is, in general, undertreated), the ALA is getting help promoting better asthma care and Bettis is making money (if indeed he is) for promoting a good cause. I guess it is hard to complain about this. The link to Advair/GSK is discrete (link on test web site, GSK and/or Advair logo on handouts) but you couldn’t exactly accuse them of hiding it.
Should Bettis disclose the GSK link (and that he is being paid, if he is) in his media spots? Maybe, but that has the effect of making it more commercial. I think as long as he doesn’t endorse Advair (and he doesn’t even seem to mention) I don’t care if they are paying him.
When I started writing this, the post was to be titled “How GlaxoSmithKline bought off the American Lung Association” but I guess having thought it through I’ve come around to a different point of view. In this case the alliance of pharma and non-profit seems to be a win-win situation (you are like Fox News, you report AND decide).
*These are also the goals according to NAEPP (National Asthma Education and Prevention Program) guidelines