It’s not the expensive meals, junkets or honoraria. It’s the fact that the drug companies are taking a huge public relations and financial beating for our mistakes! A case in point is Fen-Phen, a once popular anti-obesity drug cocktail found, about 10 years ago, to be associated with valvular heart disease and pulmonary hypertension. Class action product liability suits followed and American Home Products Corporation settled for about $4 billion, taking the monkey off the back of untold numbers of doctors who engaged in contraindicated prescribing of the two drugs in combination. The company did not promote combined use of the two drugs.
A more recent example is the pro-motility drug cisapride (Propulsid, or Prepulsid in Canada) withdrawn from the market a few months after a well publicized case of fatal cardiac arrhythmia (presumably torsade de pointes) despite the fact that the drug was being taken against product labeling. As reviewed in this article form CMAJ Johnson and Johnson, facing huge lawsuits regarding adverse cisapride related events, contended that physicians improperly used the drug. That contention was evidence based (as it is for many drugs); nevertheless, the company settled for $90 million.
Now cisapride’s in the news again as a class action suit gets underway against Canada’s Johnson and Johnson subsidiary. Again the company maintains, correctly, I believe, that “the drug ‘is a safe and effective medicine when prescribed appropriately.’" But, doctors, worry not. They’ll settle.
I wrote about this very problem in our fourth Medscape Roundtable Discussion on how to stay current on prescription drugs. So, doctors, it ain’t rocket science. Just read the product labeling. (If you got your copy of the product labeling from a drug rep be sure and wash your hands 10 times after handling).