Selling the pill like soap

The Sunday Times, May 17 1987

BRIAN DEER questions the campaign techniques of marketing a new contraceptive pill launched last week

IN Chicago last autumn I had the good fortune to take part in one of the drug industry’s regular jamborees. Top doctors, salespeople and a sprinkling of selected journalists flew in from all over the world and had an enjoyable expenses-paid week at the luxury Palmer House Hilton hotel pursuing what was dubbed “a scientific symposium” on the pill.

The international pill giant Schering AG was at that time seeking to convince doctors that they should prescribe women the company’s low-dose triphasic – known in the UK as Logynon. Since Schering also make 11 other contraceptive pills, I asked their spokesman in Chicago, a charming Dutchman called Melisse, why his company didn’t withdraw these earlier products in favour of the new one.

This seemed especially pertinent, since Logynon, and its American brand variant Tri-Levlen, were being flaunted before the world as the latest word on contraceptive safety. According to the official promotions, the triphasic pill “follows a woman’s natural hormone patterns” and is “second to none for low total hormonal dose”.

Chomping on a later-breakfast croissant, Melisse responded that if women were “getting on” with Schering’s old higher-dose monophasic pills, there was no reason for doctors to switch them. This sounded familiar, being a widely accepted view even among people who have not been flown free of charge to expensive locations, but demonstrates a complacency which puts the onus on unsuspecting women to take the initiative to change.

In a situation somewhat removed from the temptations of Chicago, it might be worth questioning the current approach to this important issue. Is it really the case that manufactured hormones, which have such a profound effect on a woman’s body, should be sold to doctors and their patients with much the same sort of fads and sales techniques as soap powders or dog food?

I can already hear the cries from doctors. “What a disgraceful suggestion,” is the most likely formulation. “It is inconceivable,” some will maintain, that family practitioners, let along specialists in family planning clinics would ever allow pharmaceuticals to go the way of Persil, or Kennomeat. No way will any pill be prescribed with anything other than the best clinical judgment.

Before they write in, however, I should draw their attention to a recent survey of 1100 women reading The Sunday Times Look page. Nearly half were currently on the pill and of these over 50% were still taking relatively high dose brands, despite the widely accepted wisdom that such pills have a greater risk of causing serious side-effects such as blood clots, which can be fatal. Another finding was that half the women were never advised about side-effect risks.

I would also ask any physician to explain the latest advertising campaign, launched last week by Schering to promote a pill which is claimed to be even better than Logynon. It is called Femodene and is so marvellous that the advertising sent to doctors is headlined “Healthy women” and asks: “Should any woman start with any other combined pill?”

What substantiates such optimism? I cannot tell – and I am sure no doctor examining the promotion can tell either. For the whole campaign to sell Femodene is so far unsupported by any published medical evidence. This is in itself extraordinary, but what is more surprising is that Schering also made such claims to newspapers about Femodene before other scientists could verify them through such published research.

Schering’s response is that a study of 24 women has been accepted for publication in the American magazine Contraception. This tiny study, however, may well be contradicted by subsequent inquiries, since little research is conclusive. And it is widely accepted that it is unethical to use the national media on behalf of a product prior to publication in a scientific journal.

Schering also point to the fact that if Femodene has a lower hormone dose than other pills it is therefore reasonable to infer that it disrupts a woman’s metabolism less and is likely to be safer. But this pill contains a completely new and stronger hormone, called gestodene, so such assertions may be the equivalent of saying that a double whisky is a smaller dose of alcohol than a pint of beer.

Of course, Femodene has been licensed by the government, through the department of health’s Committee on the Safety of Medicines. But although the CSM may do its best to safeguard the public, it has been known to be wrong. And the people who actually review the drugs data for the Committee are not often known for their specialist standing.

We cannot just accept the manufacturer’s unverified statement that a product is best – especially in the case of Femodene, which among other things, will cost the NHS twice as much as the earlier triphasic pill generation. And only last September The Sunday Times killed the idea that researchers can be automatically trusted, by exposing Professor Michael Briggs, one of Schering’s top researchers, who faked his pill safety investigations.

It could, of course, be that doctors are aware of such problems and will not prescribe Femodene until they have been satisfied by independent research published in reputable journals. Schering may be unhappy, but the joys of Chicago, or Singapore, or Santiago, or all the other places it has since set up its stalls, should not distract the drug industry from the needs of women at home in Britain.

Michael Briggs’s safety tests faked