Marketing Zyprexa

A report on the business newswire Bloomberg could have implications for a class action lawsuit approved a month ago by the Ontario Superior Court of Justice.

According to court documents filed in a suit brought by the state of Alaska, Bloomberg says, the drug company "Eli Lilly & Co. trained its sales force to downplay risks for Zyprexa and encourage doctors to prescribe the drug beyond approved uses for schizophrenia and bipolar disorder."

The story says Lily's own research found that "some patients on Zyprexa gained as much as 80 pounds and that the incidence of high blood sugar at diabetes levels was 3.5 times higher than for placebos."

Bloomberg, which filed a motion to unseal the court documents, quotes a 2002 information sheet for sales staff: "We believe it is essential to weaken this link to neutralize the diabetes/hyperglycemia issue,'' and, "Neutralizing any concern from our customers will be essential to the future growth of Zyprexa in the marketplace.''

The Alaska case was settled last March with the company paying the state $15 million (US). According to Bloomberg, the company has paid about $1.2 billion to resolve claims brought by more than 31,000 patients who said they weren't adequately warned Zyprexa could cause weight gain, diabetes or inflammation of the pancreas.

Early last month, a class action representing nearly 600,000 Canadians was given the go-ahead to sue the company for its profits from Zyprexa, alleging the company failed to warn about a diabetes risk.

Lilly spokeswoman Tarra Ryker told Bloomberg in an e-mailed that the company doesn't engage in improper marketing and hasn't downplayed the risks. The documents cited "are a tiny fraction of the more than 20 million pages'' Lilly provided, Ryker said. "They do not accurately portray our company strategy or our overall conduct.''

Zyprexa is Lilly's top-selling drug, Bloomberg said, with $4.76 billion in sales last year -- about a quarter of its total revenue.

Between 2003 and 2007, amendments were made to the drug's label in Canada that included a warning against diabetes. Zyprexa was approved by Health Canada in 1996 for treatment of bipolar disorder, schizophrenia and other mood disorders. Allegations that it causes diabetes have not been proven, but one of the drug's side effects is significant weight gain.

Access to health care

The Ontario Physicians Poverty Working Group has released a controversial new study that is sparking a fair bit of interest.

In it, the doctors chronicle the poorer health of those with lower income, saying they have less access to the health care system. Canada's universal medicare, they say, is not really all that universal. It's more accessible for the rich, so the rich have better health. They can also eat better and exercise more, so they stay healthier.

That's an over simplification, but you get the idea. It's an argument that's been made before, and few that I have seen seem to be questioning that the richer you are the healthier you are likely to be.

But there is a debate about who is to blame. It is a  debate, judging from the comments made to a column in the Star about the study, that cuts between those who blame the poor for their poor health and those who say society as a whole needs to ensure equal access.

The wider issue,it seems to me, is that equal access to health care in general is a looming issue in Canada. Some people spend years on waiting lists, waiting for surgery. Others have to fight to get their cancer treatments or their children's autism care covered, while many others  simply can't find a family doctor.

With limited funding and rising costs, access to health care is becoming a valued commodity.

Dr. House's ethics

Anyone who has watched the TV medical drama, House, has no doubt cringed once or twice as actions and utterances of the title character, Dr. Gregory House. Billed as a brilliant doctor, he is excused for his excesses because of his success rate in curing patients.

But does that make his actions ethical?

It's a good question, and one tackled by blogger Barbara Barnett. From what I can tell, she is more of a House fan than a professional ethicist, but her six-page discussion makes good reading for fans of the show and those interested in medical ethics -- or both. Also, an interesting discussion has begun on her blog about the ethics of doctors doing whatever they can to save a patient -- even if it's risky.

For an insider's look at medical ethics, check out a posting on the BBC website by Dr. Daniel Sokol, a medical ethicist at the University of London, describing what hospital ethicists do.