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MSD given CoP knuckle rap

Revisions to hypertension prescribing guidelines gave Cozaar edge over rivals

Merck Sharp & Dohme (MSD) has fallen foul of the UK pharma industry's code of practice for rewriting guidelines distributed to doctors treating high blood pressure so that its hypertension drug Cozaar was shown in a better light.

ABPI self-regulatory arm, the Prescription Medicines Code of Practice Authority (PMCPA) has ruled against the company for changing professional recommendations compiled by the British Hypertension Society (BHS).

PMCPA spokeswoman Heather Simmonds confirmed that the case report ruling would be published later this month in the quarterly CoP review on the organisation's website (www.pmcpa.org.uk).

The investigation was launched after a complaint made by No Free Lunch UK, a group of doctors lobbying for greater clampdowns on gifts and inducements given by the pharma industry to the medical professions.

The BHS had distributed information sponsored by MSD that described the so-called `ABCD algorithm' for recommended drug treatment for high blood pressure. The algorithm advises doctors which drugs to prescribe based on their patient's age, ethnic background and previous reaction to different treatments. Cheap generic versions of ACE inhibitors are generally recommended as the first treatment of choice.

However, materials paid for by MSD including cards, posters and computer mouse-mats altered the order and phrasing of the recommended hypertension drugs so that Cozaar was given greater prominence.

ìWe can confirm the adverse ruling, which we won't be appealing,î said MSD spokeswoman Tricia Persad-Bevil. ìAll the offending materials in the UK were withdrawn in December 2005.î

She added that when the materials in question were produced, MSD believed it had the approval of the BHS to alter the position of angiotensin II antagonists [the class of drug to which Cozaar belongs] on the chart, as the BHS information service considered the two classes of drug to be equal partners in the absence of compelling indications.

ìHowever MSD now understands that this course of action has resulted in the production of misleading materials,î she said.

Professor Neil Poulter, NHS president at the time the materials were sanctioned told the Financial Times that the revisions in the guidelines were ìa shame and an errorî. He said a non-medical employee of the BHS at the time had authorised the change at MSD's suggestion.

The revised ABPI Code of Practice was unveiled in November 2005, restricting the use of gifts and inducements to medical professionals as well as promising much tougher measures for companies found in serious breach of the code.

The relationship between the pharma industry and the medical professions has come under scrutiny in recent times. Last year, a health select committee (HSC) report was critical of the industry's approach to its marketing practices: `The intensive marketing which encourages inappropriate prescribing of drugs must be curbed. Present methods of supplying information are inadequate.'

30th September 2008

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