May 24, 2017

This soap opera's latest twist: A character contracts cancer—at a drugmaker's request

Daily Briefing

    When "General Hospital" ran a storyline in which a character was diagnosed with a rare cancer, Oregon physician Vinay Prasad was suspicious about why the soap opera would spotlight a disease so uncommon that it affects just two in 100,000 people. In a new JAMA paper, Prasad and his colleague shared their findings: A company that makes a treatment for the cancer was behind the episode. 

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    The company, according to the researchers, is a drugmaker called Incyte. And its sole FDA-approved drug, ruxolitinib, happens to treat the disease, a rare bone marrow cancer called polycythemia vera (PV). The researchers discovered that the episode in question aired as part of a partnership between the drugmaker and the producers of "General Hospital" "to raise awareness for [myeloproliferative neoplasm (MPN)] as part of the rare disease month." According to Incyte, there are three main types of MPN and PV is one of them.

    According to STAT News, Incyte did not respond to questions about the "General Hospital" partnership.

    A new kind of 'disease awareness' campaign

    While FDA regulates direct-to-consumer pharmaceutical marketing, it does not regulate a practice called "disease awareness," which is when a spokesperson—typically a well-known celebrity—draws attention to a disease with the idea of growing the market of consumers for the drugmaker's product, Vox reports. According to Vox, disease awareness campaigns usually mix marketing and health messages and "involve some subtle hawking of pharmaceuticals."

    Research suggests such campaigns are very effective at selling drugs—even when the campaign doesn't name the specific drug, Vox reports.   

    But Incyte's collaboration with "General Hospital" went a step further, the researchers wrote. Instead of drawing attention to their drug with traditional disease awareness campaigns, the drugmaker managed to get "General Hospital" to weave the cancer directly into the show's plot. "Writing a (rare disease) into a main character plot on daytime soap opera to our knowledge is unprecedented," Prasad said.

    The "General Hospital" plotline went like this: One of the show's main characters, Anna Devane, is diagnosed with PV. Her doctor tells her that if left untreated, the disease could lead to heart attack or stroke, and he suggests Devane begin a typical treatment regimen consisting of anticoagulation drugs and drawing blood. In response, Devane says, "But this protocol sounds like you are treating the symptoms of this cancer; how do we beat it?"

    According to Prasad and his colleague, this framing of the disease "may constitute subtle promotion of ruxolitinib." And given how very subtle the message is, "there's no way you would ever know it was connected to the drug company," Lisa Schwartz, a professor of medicine at Dartmouth University who studies pharmaceutical marketing, said.

    Schwartz explained that the "natural skepticism that comes up when you see advertising is totally down because you don't know the drug company has any role in the message you're getting."

    John Kamp—executive director of the Coalition for Healthcare Communication, a trade group for pharmaceutical marketing companies—said, "I've got to say, it's aggressive, but it's smart." He added, "The viewers of 'General Hospital' are a pretty important audience for information like this."

    The potential for public health consequences

    This blurred line between advertising and public health message could also lead to over-diagnosis, Schwartz said.

    As Prasad explained, "If every viewer of 'General Hospital' heard about PV and went to their doc to be tested for PV, we would find way more PV than actually exists." He pointed out that PV is associated with a genetic mutation that often can be found in healthy patients. He said, "There's no single diagnostic test nor a combination of tests to make the diagnosis of PV," which means there's some room for error in the diagnosis.

    In addition, Prasad said patients might start seeking the drug—which is approved as a second-line therapy and for patients with specific complicating conditions—even when it's not right for them. The disease's side effects include severe anemia and elevated risk of diseases like tuberculosis and viral infections, Belluz reports.

    As Schwartz put it, "This just seems like a terrible precedent and something needs to be addressed" (Belluz, Vox, 5/18; Garde, STAT News, 5/18; Mailankody/Prasad, JAMA, 5/18; Incyte release, 2/28; ).

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