July 8th, 2011
Pushing Western medicine with fear in India
If you sleep less than six hours a night, you’re increasing your risk of developing or dying from heart disease by 48 percent. At least, that’s what U.S.-based pharmaceutical giant Abbott would have 1.2 billion people in India believe.
But doctors say the grim message, which appeared in a newspaper ad in India earlier this year, is baseless.
In fact, they worry Abbott’s marketing campaign may be the bigger threat, scaring healthy people into buying potentially harmful sleeping pills they don’t need—such as the company’s own drug Zolfresh.
“They are implying that taking sleeping pills may help you live longer, whereas the data shows that taking sleeping pills is associated with increased mortality,” said Dr. Daniel F. Kripke, a psychiatrist at the University of California, San Diego.
Industry insiders say the ad points to a bigger problem: According to Benjamin England, an attorney formerly with the U.S. Food and Drug Administration (FDA), drugmakers have lower standards for how they operate in emerging markets like India and China, where government oversight is poor.
“You already feel like you are in the Wild West,” said England, founder of the international consulting firm FDAImports.com. “There is not likely to be anybody who is going to take them to task.”
“If there is nobody paying that much attention to what people are saying about the product, then they’ll push the envelope and say things they would not have gotten away with here,” he told Reuters Health.
And it doesn’t matter that Abbott refrains from mentioning drugs directly, which would have been illegal in India, said another lawyer formerly with the FDA.
“I would argue that if the company making the claim has a sleep product for sale in India, then this is an implicit ad for the product,” the lawyer, who spoke on condition of anonymity, told Reuters Health.
“In the U.S., companies cannot put out a scare notice without substantiation simply because they do not mention their product in the communication.”
CREATING A NEW MARKET
With soaring incomes, expanding insurance coverage and more and more chronic disease, India has become a big draw for global drugmakers. According to one McKinsey report from last year, the country’s drug market will be worth $55 billion by 2020.
Promoting sleeping pills, a staple of Western medicine, is one way to tap into that potential. Last year U.S. doctors prescribed the drugs nearly 60 million times, with sales exceeding $1.9 billion, according to the research firm IMS Health.
In India, a pack of zolpidem—the generic form of Abbott’s Zolfresh—sells for just a couple of dollars. Despite the low price, getting just a small fraction of the large population to buy sleeping pills could mean a sizable profit for drugmakers.
“Insomnia is an area where you will find a huge untapped market,” said Ram Bala, a marketing expert at the Indian School of Business in Hyderabad, who has consulted for companies like Johnson & Johnson and AstraZeneca.
He said drugmakers appear to be stepping up their efforts to win over emerging markets, although it’s an uphill battle as many Indians still prefer herbal remedies or are largely unaware of modern medicine.
“There is a lot of public resistance to treating insomnia, because they don’t think it is such an important condition,” Bala told Reuters Health. “If you bombard them with enough information about insomnia, maybe they may at some point decide, ‘Hey, you know what, there are so many people telling me that insomnia is important, maybe I should go to the doctor and check it out.’”
Indeed, Abbott’s ad encourages readers to see their doctor if they can tick off just one of 10 statements, including “I feel sleepy during the day” and “I have a feeling that my sleep is unrefreshing.”
“This is so dramatic and ridiculous,” said Dr. Adriane Fugh-Berman of Georgetown University in Washington, D.C., who runs PharmedOut, a think tank that studies drugmakers’ influence on prescribing.
“It is really advertising, but it is disguised as education,” she told Reuters Health. “Industry calls it disease awareness, those of us who are public health advocates call it disease-mongering—making people believe that they are sick when they are normal.”
Abbott declined to discuss the purpose of its campaign.