A Medical Journal And A ‘Slick’ Paper About Niaspan
10 CommentsBy Ed Silverman // July 7th, 2010 // 7:55 am
Last week, the American Journal of Cardiology published a paper that carried a curious title: “Linguistic Analysis of In-Office Dialogue Among Cardiologists, Primary Care Physicians, and Patients With Mixed Dyslipidemia.” In short, this examined the discussions between 24 doctors - 12 cardiologists and 12 primary care physicians - and 45 patients who were diagnosed with high cholsterol. The subject of their chat? Treatment with Niaspan, a drug sold by Abbott Labs.
The paper found docs didn’t do well discussing the problem and their patients are poor listeners. And the study made an interesting observation - that only one doc noted Niaspan will improve HDL and offer protection from heart blockages or development of plaque in the arteries. However, as CardioBrief pointed out, there is no evidence Niaspan does such things. Morever, the paper failed to discuss other treatments or diet and exercise, prompting the impression this was really an Abbott marketing study.
The paper, in fact, was funded by Abbott. One of the authors, Alan Brown of Midwest Heart Specialists, has a track record of contributing to AJC supplments and to CME programs, CardioBrief notes. Another author, Corey Eagan, works at MBS/Vox, which is part of the CommonHealth marketing company, which has worked on Niaspan (see here).
So we asked William Roberts, the AJC editor and the executive director of the Baylor Cardiovascular Institute of Baylor University Medical Center in Dallas, about the decision to publish this paper. “I thought this was a plus or minus article to be honest. By that I mean borderline. It was gutsy to be published, to be frank with you. But this sort of thing (cholesterol lowering discussions with patients) comes up in physician all the time,” he tells us.
“The idea that it’s really an Abbott marketing study for niaspan, I think that’s a little strong…I’m not really interested in knowing the marketing literature of every pharmaceutical company, but my own view is the American people are not treated adequately with the lipid-lowering drugs that we have,” he continues. “…I’m in favor of articles that stimulate discussion of more lipid-lowering drugs or patients to take them…I thought this was an article in a way that had a purpose, a function…”
However, Roberts does acknowledge flaws. “It’s not the ideal authorship, by any means…If you look at the 650 articles published in the AJC each year, this is an exception….Is the quality diluted or contaminated if there is a pharmaceutical person as an author on the manuscript? You can debate that a good while…If i had to do it over again, I certainly woudn’t have allowed a single drug to be mentioned…In retrospect, discussion or mention of one drug and not a whole bunch of them is a little slick.”
elmore
I’d love to see the pub plan that generated this.
Costello
Good grief. “A _little_ slick?…..”
Hey, Abbbbotttttttt!!!!!!!!!!!
Former Big Pharma
I think this company and others has been suggesting this type of research for several years. It seems to me that it’s very bold to link it up with a specific drug, but how else would they get Abbott to fund it? It is PR, even if it’s value for publication in the AJC is very debatable. personally, I don’t think so.
Justice in MI
Reminds me of those movies that always had a can of Coke somewhere….
As far as I know, studies so far do show that Niaspan raises HDL in a signicant percentage of users, but–to this point–it has not been correlated with better CV outcomes.
Do others agree with that summary?
M Helm, MD
J Cardiovasc Pharmacol Ther. 2010 Jun;15(2):158-66. Epub 2010 Mar 5.
Effect of niacin therapy on cardiovascular outcomes in patients with coronary artery disease.
Duggal JK,
From the abstract: “Niacin or nicotinic acid (vitamin B3) raises the levels of high-density lipoprotein cholesterol (HDL) by about 30% to 35%. In patients with prior coronary disease, 7 trials have been published on clinical cardiovascular disease outcomes and the results, not surprisingly, are inconsistent”
This meta-analysis conclusion: “In a meta-analysis of seven trials of secondary prevention, niacin was associated with a significant reduction in cardiovascular events and possible small but non-significant decreases in coronary and cardiovascular mortality.” The events they identified with statistically significant reductions in risk (which is not the same as clinically signficant) were: coronary artery revascularization, non-fatal MI, stroke and TIA. There was no definite benefit for reducing cardiovascular disease related death. If you are willing to believe a meta-analysis of manufacturer-sponsored trials.
Niacin makes you lipid profile look better, but that doesn’t necessarily mean anything more than that your lipid profile looks better. Exercise also effectively raises HDL (and typically leads to weight loss and other metabolic improvements).
Using niacin to positively affect HDL at least makes more sense than using rosuvastatin or atorvastatin to accomplish that goal. I have heard of physicians attempting that approach.
Irene
Unless something has changed drastically, Roberts is a very hands-on EIC. No way he didn’t review this manuscript, and who/where were the peer reviewers?
And speaking of transparency, Roberts is the same guy who used to remove medical writers/editors from the Acknowledgments if they were the only ones listed. Nice.
Justice in MI
Thanks, Doc Helm.
SteveM
Re: Dr. Helm
I just saw a Niaspan commercial on TV for the first time tonight. As a layman, but also a scientist, its professed clinical value was cryptic.
I can only imagine the exaggerated conclusions inferred by the average person inundated with that kind of skewed med-speak.
DTC advertising is messed up…
Barney
Seems to me that Abbott ought to be looking for a new Agency!!!
chris
I found this site after searching on Niaspan because the commercials are so obtuse, meaningless and emotionally manipulative that I was offended.
I am glad your site looks deeper into this PR hype and gives honest information.
With commercials such as this around, doctors must get peeved when their patients come in whining for a drug they really know nothing about.
Thanks again.