Get the widow on the set, we need dirty laundry.
Thursday morning on the Today Show, Katie Couric spoke with Forbes managing editor Dennis Kneale (see the clip here). Kneale was discussing this article in Forbes magazine about the GlaxoSmithkline Asthma drug Advair, and concerns about its safety. The overall question is an important one, worth consideration: what do you do when a drug helps millions, yet can be harmful or fatal to a small percentage. I have a real problem with the way this article, and Kneale's comments on the Today Show, frame the issue.
When I first heard about possible dangers of Advair, I consulted with a friend who is both an MD and asthma sufferer. Advair actually contains two drugs. One is a steroid, the same steroid found in the GlaxoSmithkline's Flovent, which eases inflamation of the airways. The second, a bronchodilator that expands constricted airways, is the same drug found in the GlaxoSmithkline product Serevent. It belongs to a class of drug called beta agonists. All bronchodilators I know of are beta agonists, and some people have adverse reactions to them. The problem with Serevent is that it lasts longer (12 hours instead of 4-6), so an adverse reaction will go on longer before symptoms subside.
The article opens with two stories of people suffering reactions to Advair. One person said that, despite complaints of ill effects, his doctor said to keep taking it (sounds like the doctor's fault to me). The second was another story of someone suffering ill effects who continued to take the drug, an includes visual that is gratuitously repeated throughout the article: dying while still clutching the inhaler.
The the article highlights Advair's popularity, noting the advertising dollars spent. I can't argue with that; I am against prescription drug advertising. I didn't like the way the discussed Advair's "nifty delivery system," which they called a "purple plastic puck." Kneale also uses the purple puck term in the interview, telling Katie how "doctors love gadgets." His tone suggests that it's some kind of unecessay gimmick product, the asthma equivalent of the Swiffer.
In fact, the Advair Diskus (as it's called) is a vastly superior delivery method. Aerosol inhalers required the user to inhale at the moment as the push the cannister down. If you're off (as I was from time to time), you end up spraying most of the drug on the back of your throat instead of inhaling it. Further, unless you kept careful count of uses, you didn't know quite when the inhaler was empty. Finally, you needed between 2 and 4 inhalations, 60 second apart, each time you take it. Advair has a little number that decreases with each use. It turns red when you're under ten doses left. When you inhale, the force of your breath draws out the drug, so you always inhale it properly. Finally, you only need to inhale once each time. That's as much of a gimmick as anti-lock brakes.
Another issue they highlight is overprescribing. One of the people in the openning paragraph also had a persistent cough and wheeze, but was not diagnosed with asthma. Kneale talks about how his doctor prescribed it to him for a persistent cough from bronchitis. He doesn't say if it helped or not. The article also notes that Advair is being prescribed to more than just severe asthma sufferers. I thought that was unfair. My asthma was never severe or life threatenning, but it is still very important to my long term health that it be kept well controlled.
The article and Kneale play free an loose with the numbers. The first statistic the present is a single doctor's assertion that Advair and Serevent are killing 4000-5000 people a year. Only later do the note studies that showed numbers like 12 out of 17000, still taking time to suggest that this finding was inappropriately deemed statistically insignificant. When numbers minimize the risk, the article's tone is always questioning. They never cast doubt on the 4000 deaths/year estimate.
They also mix in statistics for other bronchodilators, like in this paragraph:
But Serevent had been under suspicion from the start, and earlier beta agonists had stirred doubts for decades. In 1948 one study of 2,200 asthma patients found a fivefold-higher death rate for patients who inhaled epinephrine, a beta drug, versus those who hadn't."
First off, I checked and found that almost all bronchodilators are beta-agonists. This article doesn't mention that. Non-beta bronchodilators are not inhaled - they're taking orally, so the side effects tend to be worst. Theophylline is non-beta example I've taken, and it sucked. As for epinephrine, the article is correct about its dangers. I've taken it - it's awful stuff. What the article failes to mention is that more modern beta drugs, Serevent included, are a vast improvement. To read the Forbes article, you'd think epinephrine and Serevent are like Motrin and Advil.
The article does everything it can to hype the danger aspect of Advair. They're searching for the next big drug company scandal.The article says as much when it conjures up the spectre of Merck's Vioxx and Wyeth's Redux. I'm all for keeping the drug companies honest, mind you, but Forbes this article is heavy drama and a light cogent fact. There is next to no mention of the drugs success in controlling asthma and similar respitory ailments. In my opinion, that success is the real reason for Advair's popularity.
There are also no anecdotal stories of people who's lives have improved thanks to Advair. So, here's one:
When doctors, insurance companies, etc. try to assess how well you are managing your asthma, they want to know how often you use your rescue inhaler. A rescue inhaler is a fast acting bronchodilater you use when you're having an attack. If you are using it often, you asthma is not well controlled, and you could be doing harm. Since I began taking Advair, I have all but stopped using my rescue inhaler. If I use it three times a month, it's a lot. I used to use it at least that many times a week. My respitory health has improved drastically thanks to this drug.
I'm one of the millions it's helped. I'd prefer a little less media hype about this one.
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