American-style free market healthcare can often leave consumers confused. If you are a typical denizen of the U.S. you have surely been exposed to thousands of television and internet ads by big pharmaceutical companies promoting products that do everything from thinning blood to improving erections. Currently only the United States and New Zealand allow such direct-to-consumer advertising. Virtually all other countries have banned it. But those ads can make millions more for Big Pharma since the result is often patients demanding the more expensive named-brand drugs.
Adding a counterpoint to the drug ads, and even more confusion for consumers, law firms troll the same airwaves for potential claimants in lawsuits against those same pharmaceutical companies. It is a strange phenomenon indeed and I see the results play out in my practice sometimes.
A case in point: Until recently, Warfarin, perhaps best known as Coumadin, was the only drug available to significantly reduce the risk of stroke in patients with an irregular heart rhythm known as atrial fibrillation. But Warfarin, named after the Wisconsin Alumni Research Foundation, or WARF, is a drug with significant problems. Initially, because the ingestion of too much of it will cause anyone, or anything, to bleed to death, it was marketed as rat poison. Later, when prescribed in carefully monitored doses, it has been used to thin patients’ blood.
But Warfarin can interact with many other drugs, causing a patient’s blood to be too thin or not coagulate at all (a simple drug like Tylenol can cause a patient’s Coumadin levels to skyrocket and possibly result in a life threatening bleed). Also, Warfarin works by competing with Vitamin K, an important Vitamin needed to make clotting factors, so patients who eat too much green leafy vegetable material may see their Warfarin become ineffective, thus increasing the likelihood of a stroke.
With Coumadin posing a significant risk, not preventing as many strokes as doctors had expected, and the difficulties patients have in using the drug, replacement drugs have been sought after for years. The first of these drugs, Pradaxa, appears to be a better, more effective, and a safer alternative to Coumadin. But like any other blood thinner it too can cause bleeding.
I recently had an encounter with a patient who watched, in shock, a television ad portraying this new drug as problematic and dangerous. He sat in my waiting room anxiously waiting to see me. He was concerned that I had prescribed a medication, to prevent a stroke, as a result of his irregular rhythm, that could cause him to hemorrhage to death. “It’s all over the TV,” he told me. “I saw it on the commercials. Pradaxa is causing people to bleed to death and I stopped it. I don’t think I should be taking a drug that can make you bleed like that. People are suing too.”
He had mistakenly placed himself at risk of a stroke by stopping the drug and spent his time and precious money (cost of a cab and the visit), to come to my office because he was convinced by a very convincing Madison Avenue ad that he was taking a dangerous drug.
Since many patients with atrial fibrillation are elderly and perhaps more easily persuaded by these slick ads, such ads represent a kind of public health risk. It took me an entire visit to educate him, again, about the risks and benefits of Pradaxa compared to Coumadin, and after our visit the patient decided to continue his Pradaxa. Lucky for him he did not have a stroke during the few weeks he was not anticoagulated with Pradaxa.
Pradaxa is a relatively new drug used, but it can significantly reduce the risk of stroke in patients who have an arrhythmia known as atrial fibrillation. In very large, unbiased, and randomized trials, when compared to Warfarin, the standard therapy to thin a patient’s blood who has atrial fibrillation, Pradaxa was shown to significantly reduce stokes and life threatening intracranial bleeding. And the patients who took Coumadin in this study, which is often not the case in clinical practice were very closely monitored; something that is quite difficult in the real world.
The fact is that Pradaxa does reduce the blood from clotting (some might say it does thin the blood) and like any blood thinner, whether it is Coumadin, or even Aspirin, or Pradaxa, it can increase the risk of bleeding. This is something that will happen anytime you take any blood thinner. Fall down and bang yourself while taking Coumadin or Pradaxa and you will bleed more than if you weren’t taking it.
There are going to be patients who have horrible bleeds on Pradaxa, as there are on Coumadin, but Pradaxa, it appears, is simply a better drug than Coumadin. It works better, it is safer, you don’t have the same dietary restrictions you must adhere to if you take Coumadin (can’t eat foods with Vitamin K) and you don’t have to run to the doctor’s office to have your blood checked, like those on Coumadin do, at least every month.
But the free market is about making money, so there are firms out there putting millions into commercials, fishing for people who had a bleed while taking the drug (even though it is a known risk for any drug that thins the blood). It may be that some of these people do deserve compensation, but what is clearly dangerous is that these ads seem to be causing some patients to stop taking critical medications! And if you stop Pradaxa, because you were frightened by some commercial, you will increase your risk of having a stroke.
Many of the ads would scare me, if I did not know the drug to be an important agent to reduce the risk of stroke. Here’s a line from one of them:
If you or a loved one took Pradaxa and then suffered serious internal bleeding, a stroke, or even died, you may be entitled to compensation! Call 1 800……
And another one
It has been reported to xxx xxxxxxx that Boehringer Ingelheim Inc, the manufacturer of Pradaxa is aware of numerous deaths related to Pradaxa and Hemorrhaging yet we are not aware of any move on the part of Boehringer Ingelheim Inc. to remove Pradaxa from the market.
Perhaps the good lawyers out there should counter this commercial with their own:
If you or your loved one stopped taking Pradaxa, because of a commercial on TV , which inappropriately judged Pradaxa as a drug that is likely to harm someone, and then suffered a devastating stroke because of this, then call the law offices of XXX at 1 800…… You may be entitled to compensation from the law firm who irresponsibly convinced your loved one to stop taking their medication.
Dr. Evan S. Levine is a cardiologist in New York and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.