The Zetia and Vytorin Controversy

The recent Zetia/Vytorin study controversy reminds us that pharmaceutical advertisements may be more powerful than patients and doctors realize.

The pharmaceutical companies Merck and Schering-Plough released the results of their ENHANCE trial: Zetia (ezetimibe) and Vytorin (ezetimibe/simvastatin) do not appear to lower cholesterol enough to lower the risk of heart attack and stroke. Statin drugs, like Zocor, have been proven to lower cholesterol by inhibiting the body's formation of cholesterol. Ezetimibe lowers cholesterol by blocking its absorption from the intestines, but this study demonstrates that it doesn't do much alone (Zetia) or together with a statin (Vytorin).

This may come as a shock to patients in the United States, where drug ads are rampant. You've probably seen the television commercial for Vytorin, pointing out that cholesterol comes from food and family and that Vytorin treats both sources. It sounds good, yet the ENHANCE trial is not supporting it.

Pharmaceutical marketing is a major issue, not just for patients who demand a medication they see on TV but also for doctors who are swayed by pharmaceutical sales representatives. I remember a lecture in my medical school's pharmacology course. It taught me one surprising fact: drug companies spend more money on advertising than the research and development of the drug itself.

I've seen these tactics in action. Drug reps will buy tons of free food for doctors in residency programs during their midday lectures. They will stop by clinics that do not restrict their visitation privileges. They will even take doctors out to dinner and a medical conference. Whatever they do, they throw in pens and other gifts with the drug name branded on them.

Patients and physicians need to step back and realize what's important: solid evidence. Regardless of what advertisements claim, only a well designed clinical trial can tell if the drug is efficacious and safe.

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