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RESEARCH BRIEFSDrug Ads Take Increasing--Though Still Small--Share of Pharmaceutical Promotion BudgetSpending on direct-to-consumer advertising of prescription drugs increased threefold to nearly $2.5 billion a year between 1996 and 2000, a new study led by HSPH researchers has found. Meredith Rosenthal, HSPH assistant professor of health economics and policy in the Department of Health Policy and Management; Arnold Epstein, the John H. Foster professor of health policy and management and head of that department at HSPH; and co-authors from HMS and MIT performed the first analysis of advertising patterns before and after 1997 guidelines from the Food and Drug Administration clarified the requirements for consumer ads. They used information from two companies, Competitive Media Reporting and IMS Health, that collect data on drug sales and advertising. The report appears in the Feb. 14 New England Journal of Medicine.
Pharmaceutical company spending on consumer advertising has risen markedly since 1996, but total promotional spending as a percentage of sales has remained steady. The greatest growth occurred in TV advertising, which increased more than sevenfold. However, consumer ads still account for a small proportion of all drug company spending on drug promotion, rising from 9 percent in 1996 to about 16 percent in 2000. These figures represent 1.2 percent and 2.2 percent, respectively, of total drug sales revenue (see chart). The proportion of drug revenues spent on all promotional efforts remained fairly constant at about 14 to 15 percent over the study period. More than 80 percent of promotional spending goes to personal visits of drug representatives with physicians, free samples, and print ads in medical journals. Unlike advertising to medical professionals, direct-to-consumer advertising is highly concentrated on popular drugs with relatively uncommon and mild side effects. The top 20 drugs accounted for 60 percent of spending in this area. Drugs most heavily promoted to consumers include the anti-inflammatory Vioxx, the antireflux agent Prilosec, the antihistamine Claritin, the antidepressant Paxil, the cholesterol-lowering drug Zocor, and the erectile drug Viagra. Although they document substantial growth in direct-to-consumer advertising, the findings run counter to perceptions that this type of advertising is coming to dominate drug companies' promotional spending. The authors suggest this perception may be a result of the rapid growth and high visibility of TV drug ads. Still uncertain are the public health and economic consequences of consumer drug advertising. "We simply have no evidence yet on the appropriateness of prescribing that results from consumers requesting an advertised drug," said Rosenthal. "Conceivably, advertising could improve health through raising awareness of a treatable condition or have a negative effect if it leads to unnecessary and inappropriate prescribing."
Drought Found to Be Early Predictor of West Nile VirusAreas of potential drought in New England and elsewhere in the U.S., as well as the Caribbean and Central and South America, should be alert to the risk of West Nile virus this summer, according to a study by HMS researchers that appears in the December/January Global Change and Human Health."Our study, which looked at patterns from a virus similar to West Nile and West Nile itself, found that drought amplified the cycling of the virus in mosquitoes and birds, which can then lead to outbreaks in humans," said Paul Epstein, HMS instructor in medicine at the Center for Health and the Global Environment. West Nile virus first appeared in the U.S. in 1999, concentrated in the Queens borough of New York City. The outbreak caused 59 cases of meningoencephalitis, seven of them fatal, and many of those who recovered have continuing health problems. Since that time, infected dead birds have been found in other states, raising concern and controversy in many communities each spring and summer around the balancing of risks involved in spraying pesticides to kill Culex pipiens, the virus-carrying mosquito. Epstein, and Caroline Defilippo, a former Harvard student now at the University of Adelaide, Australia, analyzed weather patterns associated with the four urban outbreaks of West Nile since 1999 and 24 U.S. outbreaks of St. Louis encephalitis (SLE), a virus with a similar life cycle also carried by C. pipiens mosquitoes. Outbreaks of SLE have been reported in the U.S. since 1933, making it a good model to compare West Nile's likely future paths and to examine prevention efforts. Examining weather records from the National Climatic Data Center, Epstein and Defilippo found that 10 of the first 12 U.S. outbreaks of SLE, from 1933 to 1973, occurred following two months or more of drought. (SLE outbreaks since 1973 show a more complex pattern, following either drought or anomalous rains.) Each of four recent outbreaks of West Nile virus--in New York, Romania (1996), Russia (1999), and Israel (2000)--occurred following drought. The reason appears to be that mosquitoes thrive in the organically rich water that forms during drought in urban wet spots, including storm drains, catch basins, and even abandoned tires. Other factors, such as inadequate sanitation and sluggish urban waterways, may increase vulnerability to urban outbreaks. Each new outbreak requires introduction or reintroduction of the virus--primarily via birds or other wildlife--so there have been seasons without SLE outbreaks despite multimonth drought. "As the potential risks from pesticides for disease control must be weighed against the health risks of the disease," the authors write, "an early warning system of conditions conducive to [outbreaks] could help initiate timely preventive measures, and potentially limit chemical interventions." One way to minimize pesticide use, they suggest, could be to maintain better flow of rivers and streams through urban areas, supporting growth of fish that eat mosquito larvae.
T Helper Cell Surface Protein Discovered, Role in Autoimmunity, AllergyThe two types of T helper cells, Th1 and Th2, produce different cytokines and are involved in different immune functions and diseases. But few molecules have been found on the cell surface that distinguish between the two.HMS researchers have discovered one of the first, a protein they call Tim-3 (T-cell immunoglobulin-and mucin-domain-containing molecule), which may have therapeutic implications for autoimmune diseases, asthma, and allergies. The study appears in the Jan. 31 Nature. Lead author and HMS research fellow Laurent Monney, with senior author Vijay Kuchroo, HMS associate professor of neurology at Brigham and Women's Hospital, and colleagues at BWH and the Dana-Farber Cancer Institute, immunized rats with several Th1 cell clones, then used these animals to generate and screen about 20,000 monoclonal antibodies. Two of the antibodies recognized a protein present on Th1 but not Th2 cells. The researchers cloned the gene for this protein, naming it Tim-3. They examined the effects of anti-Tim-3 antibodies on mice with experimental autoimmune encephalitis (EAE), a murine model of multiple sclerosis. Mice treated with the antibodies rapidly developed a more severe disease than controls, with greater inflammation and demyelination. The spleens of the treated mice contained higher numbers of activated macrophages, a cell type responsible for demyelination in EAE. These findings suggest that Tim-3 affects the interaction between T cells and macrophages. It is uncertain how anti-Tim-3 antibody boosts macrophages, though the authors suggest potential mechanisms, including antibody interference with a macrophage-inhibitory function of Tim-3. Because Th1 and Th2 cells cross-regulate each other's functions, the authors suggest that Tim-3 may play a role in the asthma and allergic reactions mediated by Th2 cells. Findings from a 2001 Stanford University study of asthma-resistant mice provide evidence for the role in asthma of Tim-3 and the related Tim-1 gene. --Briefs by Tom Reynolds |
