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Until the publication of the ALLHAT study [1] there was little, if
any,
evidence of the clinical benefit of amlodipine in the treatment of
hypertension. Nevertheless, as testimony to the marketing success of
Pfizer, amlodipine, sold in the UK as Istin and in the USA as Norvasc,
has become the world's biggest selling antihypertensive. Pfizer are
naturally keen to publicise the results from ALLHAT, which demonstrate
for the first time both the efficacy and safety of their drug. A number of
medical journals, including the BMJ, have recently printed an
advertisement for amlodipine in which it is claimed "with the results of
the ALLHAT study, lowering blood pressure with Istin in high risk
hypertensive patients is now proven to be equivalent to a diuretic in
stroke outcome".
While the advertisement is factually correct, unsurprisingly, it
fails to
mention the relative cost of amlodipine. According to the latest British
National Formulary prices it costs about 16 times more to treat
hypertension with amlodipine than it does with bendrofluazide, the most
commonly prescribed thiazide diuretic in the UK. If equivalent efficacy is
accepted, this makes amlodipine about 1/16th as cost effective. Given
that hypertension is the commonest treatable chronic medical condition
in the UK, a treatment strategy based on amlodipine would be wasteful.
Most would agree that those who prescribe have a duty to consider
cost
effectiveness, especially where there is a choice of effective treatments
[2]. In light of this, it is disappointing that major medical journals,
particularly those that have championed transparency in health service-
industry partnership, are prepared to accept adverts that contain
information that may be considered misleading. We suggest that
reputable journals should take account of any potentially misleading
content in deciding which adverts to publish.
1. Major outcomes in high-risk hypertensive patients randomized to
angiotensin-converting enzyme inhibitor or calcium channel blocker vs
diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-97.
2. Gillon R. Medical ethics: four principles plus attention to scope.
Br
Med J 1994;309:184-8.
Competing interests:
Dr Oliver holds an
educational research grant
from Pfizer Ltd
Competing interests:
No competing interests
15 April 2003
James J Oliver
Specialist Registrar in Clinical Pharmacology
Dr Simon R Maxwell
Clinical Pharmacology Unit, Western General Hospital, Edinburgh, EH4 2XU
Journals should be more rigorous in selecting which pharmaceutical industry adverts to publish
Until the publication of the ALLHAT study [1] there was little, if
any,
evidence of the clinical benefit of amlodipine in the treatment of
hypertension. Nevertheless, as testimony to the marketing success of
Pfizer, amlodipine, sold in the UK as Istin and in the USA as Norvasc,
has become the world's biggest selling antihypertensive. Pfizer are
naturally keen to publicise the results from ALLHAT, which demonstrate
for the first time both the efficacy and safety of their drug. A number of
medical journals, including the BMJ, have recently printed an
advertisement for amlodipine in which it is claimed "with the results of
the ALLHAT study, lowering blood pressure with Istin in high risk
hypertensive patients is now proven to be equivalent to a diuretic in
stroke outcome".
While the advertisement is factually correct, unsurprisingly, it
fails to
mention the relative cost of amlodipine. According to the latest British
National Formulary prices it costs about 16 times more to treat
hypertension with amlodipine than it does with bendrofluazide, the most
commonly prescribed thiazide diuretic in the UK. If equivalent efficacy is
accepted, this makes amlodipine about 1/16th as cost effective. Given
that hypertension is the commonest treatable chronic medical condition
in the UK, a treatment strategy based on amlodipine would be wasteful.
Most would agree that those who prescribe have a duty to consider
cost
effectiveness, especially where there is a choice of effective treatments
[2]. In light of this, it is disappointing that major medical journals,
particularly those that have championed transparency in health service-
industry partnership, are prepared to accept adverts that contain
information that may be considered misleading. We suggest that
reputable journals should take account of any potentially misleading
content in deciding which adverts to publish.
1. Major outcomes in high-risk hypertensive patients randomized to
angiotensin-converting enzyme inhibitor or calcium channel blocker vs
diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-97.
2. Gillon R. Medical ethics: four principles plus attention to scope.
Br
Med J 1994;309:184-8.
Competing interests:
Dr Oliver holds an
educational research grant
from Pfizer Ltd
Competing interests: No competing interests