Albumin industry launches global promotion

The plasma products industry has launched a £1.4m ($2.2m) international programme to promote albumin despite recent official advice to restrict its use to very limited indications. Albumin use has declined substantially following publication of a systematic review by the Cochrane Group, which raised serious concerns about the product's use in critically ill patients (BMJ 1998;317:235-40).

One year after publication of the review, the Committee on Safety of Medicines advised doctors to restrict its use to the treatment of hypovolaemia (BMJ 1999;318:1643). Internal industry documents passed to the BMJ outline an “albumin support” programme aimed at countering the “threats to allowable indications and the competition from alternative products.”

The global albumin market was worth £900000 in 1996. Documents from the Inter-national Plasma Products Industry Association (IPPIA) and the European Association of the Plasma Products Industry (EAPPI) outline two kinds of strategy—data collection—and “promotional.” The documents show that the associations have completed their own literature review and compiled a “Cochrane critique dossier.”

They have bought a large database to “identify/provide health economics data that supports use of albumin both alone and versus substitutes.” They have also established a medical advisory panel. Promotional activities will be “primarily centred around scientific conferences.” The documents acknowledge the need for a marketing campaign: “Certainly in the US, IPPIA will have, in comparison with the European program, a strong marketing component.”

Other recommendations include creating a website and holding workshops to develop monographs on fluid resuscitation of critically ill people. Members of the European Plasma Fractionation Association (EPFA), another organisation representing the industry, may be joining the support programme. In a fax to its members dated 16 November 1999, Richard Walker, president of the association, wrote: “I believe this is a very good program and therefore recommend EPFA members to participate … Participation in this program will be very cost effective with respect to our needs to support the use of albumin (the financial contribution per member would be about the same as the EPFA annual membership fee).”

Mr Walker is also the chief executive of Bio Products Laboratory, which is part of the National Blood Authority, a special NHS health authority. Asked about the possibility of a conflict of interest between his advice to EPFA members and his NHS position, he commented: “I don't see a conflict of interest. At [Bio Products Laboratory] we are supplying products to meet patient needs. We are very clear that we will only promote products on the basis of scientific information.” His company, he said, would not be joining the albumin support programme, although individual EPFA members might still do so. The agreed funding for the programme includes £1.6m from US pharmaceutical companies, including Alpha, Baxter, Bayer, and Centeon (now Aventis Behring). A clinical study in Italy is already under way, with funding of £87500 from local companies.

Young patients of the Chelsea and Westminster Hospital with works chosen for inclusion in the Royal College of Physicians' children's art exhibition

(Credit: ANETTE HAUG)