Crikey has discovered public hospital “guidelines”, recommending widespread use of a drug to stop serious blood clots, have been funded by the drug company that makes the drug.
Several sources close to the action told Crikey the NSW Health Department is planning to use the drug company-funded guidelines in its hospitals, without disclosure of the fact of drug company sponsorship.
The “best practice” guidelines, prepared by a panel of experts, enthusiastically recommend using a group of drugs, including enoxaparin, to treat and prevent serious blood clots, the problem technically known as Venous Thromboembolism. The small print on one booklet version of the guidelines reveals they were supported by a “non-directed grant” from Sanofi-Aventis, the global drug giant which markets enoxaparin.
The fear is the drug company-funded guidelines will be used to justify calls for widespread use of the drug, in people who may not actually need it. In fact such calls are already occurring. A recent article in the Sydney Morning Herald quoted one member of the drug company-backed panel claiming “all patients” in New South Wales hospitals should be given an injection of drugs to prevent serious clots.
A national expert on prescription medicines, Professor Alasdair Millar, says suggestions that all patients be given the drug are “extreme and scandalous”, and “could cause more harm than good.”
A clinical pharmacologist based at the Royal Perth Hospital, Professor Millar is currently writing a series of medical journal articles on the anti-clot drug, and is calling for more public scrutiny of the drug company-funded “guidelines”.
While the drug is valuable for many people in hospital, in that it can reduce the risk of serious clots, in rare cases it can cause the side effect of serious bleeding. The problem is that for some people at very low risk of developing a serious clot, the drug may actually cause more harm than good.
A spokesperson for the Health Minister in NSW confirmed yesterday the guidelines would be distributed in hospitals, without any reference to the drug company which helped fund them, because “the opinions” expressed in the guidelines were those of the expert panel.
Meanwhile Robyn Ridings, from a company called Health Education and Management Innovations, which publishes the guidelines, confirmed Sanofi-Aventis and a number of other companies, had helped fund the guidelines, and even sponsored meetings of the expert panel. Sanofi-Aventis public relations staff did not respond to emails or phone calls.
I am pretty sure that a number of hospitals in Victoria, including Box Hill, are already routinely using this drug . I have no history of blood clots or related issues but during a stay I was given the injection each day. The nurse told me that all in-patients were given the drug to stop blood clots that can form in bed-ridden patients – I still got it even though I got out of bed and went for walks and physio each day.
Now that is a nice cosy little relationship between the NSW Department of Health and a drug company.
Nice one and no disclosure either. No need to bother the punters with that one. Is anyone in NSW watching the government or are they all out watching football?
Enoxaparin is widely used in SA for thromboprophylaxis in orthopaedic inpatients. Heparin is an alternative. Deep vein thrombosis and the possibility of subsequent pulmonary embolism are very real risks of immobilisation. There is considerable concern amongst some orthopaedic surgeons that enoxaparin is implicated in wound breakdown and poor healing in lower limb surgery. Junior staff doctors do not know life without enoxaparin and therefore are not able to identify the difference in wound healing. The American College of Chest Physicians seem to hold the last word on this subject and prescribe anticoagulation guidelines. Many orthopaedic surgeons dispute the right of the ACCP to dictate management of their patients. The chest physicians have very strong evidence to support their argument. The argument not to treat will never be so enthusiastically funded.
I am afraid that this is just another example of 18th. Century medical/business attitudes being applied to 21st. Century technology. Health – as opposed to “the Health Industry”, Private Medical Practice and Business – in the same sentence is an oxymoron (but an highly profitable one). Not another big idea for 2020!