Dr. Andy

Reflections on medicine and biology among other things

Wednesday, May 11, 2005

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


At 11:40 AM, Anonymous Anonymous said...

Two things:
1) I "love" my little purple disk. Being addicted to breathing the way I am and realizing how much easier the Advair makes it, it's a close third to food and water on my list of things I'd need on a desert island. (My rescue inhaler would be 4th, unless like on ABC's LOST there's a convenient supply of eucalyptus around.) Whatever GSK can do to make people more aware that their doctor can help them control their asthma is fine by me.
2) I think that Jerome Bettis may be doing these announcements for the ALA as part of the NFL's community service initiative. They are also quite involved in the United Way and in Autism Awareness. That's strictly speculation on my part though.
Happy Breathing, Myssi

At 1:40 PM, Blogger American Lung Association of Minnesota said...

We had an internal email discussion this morning on corporate partnerships and nonprofit health charities like us.

While some can try to reframe our corporate partnerships into a "conflict of interest" (we have one pro-smoke zealot who blogs on this endlessly), the truth is most nonprofits today need the financial resources that only a corporate partner can provide to make a big splash in public awareness of a disease like asthma.

While we always need to be careful (we have a firm policy that we NEVER endorse products or services), the payoffs to partnerships can be "win-win," as Dr. Andy wisely concludes.

Say, Dr. Andy, would you consider us for your blog roll? We are (we believe) the first Lung Association to create an official blog. Please visit us often!

At 1:42 PM, Blogger American Lung Association of Minnesota said...

Oops, bad link!

Here's our blog:


At 9:01 AM, Blogger Dr. Andy said...

Thanks for the comments. Advair is a great medicine (but wait until Symbicort comes).

While in this case, I think the ALA is okay to take pharma money, I'm not so sanguine about the practice in general. As I've blogged before (http://doctorandy.blogspot.com/2005/04/
elidel-and-protopic-manufacturers-fund.html), it can lead to real conflicts of interest. For example, what if new concerning saftey data about Advair came ouu, suggesting the salmeterol component was not as safe as thought ? Would the ALA feel free to come out and say it should be withdrawn from the market, or would it feel compelled to defend it as several eczema advocacy groups did when data on the link between Protopic, Elidel and cancer came out?

At 9:48 PM, Blogger Michelle said...

I was intrigued by the fact that my 8 year old (who has moderate, generally well-controlled asthma) walked into the kitchen last week asking to take the test and make an appointment with his doctor to talk about it. Part of me was glad that he understands the need to regularly assess his asthma, the other part was appalled at how effective the advertising was!

At 11:19 AM, Anonymous Anonymous said...

With the recent FDA Health advisory concerning the LABA component of Advair I find it very interesting that the ALA is willing to support, even unbranded, a control test that leads potential patients directly into the branded Advair website. Especially considering the fact that it winds up recommending that even the mild/moderate asthma sufferer should consider a medication like Advair. Yes, Advair works very well and is an amazing medication, but should people who dont necessarily need that strength be led to try it?

Furthermore, should the ALA be concerned about promoting this link in light of the FDA health advisory recommending that Advair now be used only as a second line treatment?

Lastly, Jerome Bettis is most certainly being paid by GSK, and there are many links between the unbranded control test commercials and Advair's Control test that is blanketing the nation in magazines. Too close? well, perhaps.

At 10:07 AM, Anonymous generic viagra online said...

Well greetings thanks for the opportunity of post a message , also i would like to know more about Lung Association and GSK is very interesting , how can i get more information about it , I want to sign up for more details.


Post a Comment

<< Home