Big Pharma and Women in Government – Partnering for HPV Legislation

Much of the push to mandate coverage of the HPV testing and the HPV vaccine is coming from the Women in Government’s Challenge to Eliminate Cervical Cancer, a campaign that appears to be funded in part by the makers of the HPV test and HPV vaccine.

The Challenge, begun in 2004, has an ambitious agenda to eliminate cervical cancer in the United States, and seeks to “mobilizes state legislators to address cervical cancer prevention in their states.” According to a recent NEJM article entitled “Ethics and the HPV Vaccination“:

Women In Government, a Washington-based, bipartisan organization of female legislators, is leading a push to make HPV vaccination compulsory in every state. The group has issued recommendations for ensuring that the vaccine is accessible and affordable, including a recommendation that states add it to their Medicaid programs and encourage private health plans to cover it. The group follows in the tradition of breast-cancer activists, who have mobilized through many political channels to combat an illness that disproportionately burdens women.

Membership of the WIG, a 501 (c)(3) non-profit entity, includes female state legislators from all over the US. The group has a large list of policy issues they consider important – quite extensive and quite impressive. They appear to be taking on chronic kidney disease and higher education funding with a similar energy to their cervical cancer campaign. It’s an ambitious agenda that most certainly requires funding.

Who funds the WIG?

Like every non-profit, the WIG has lots and lots of corporate partners, and most of Big Pharma is there. But what the WIG also has is something called the Business Council, a tiny group of sponsors who seem to be much more intimately involved in the organization than most corporate sponsors of non-profits. From the WIG website –

The Women In Government Business Council is comprised of a small, select group of industry leaders. Business Council members support the overall mission of Women in Government and provide a private sector perspective to our programs. Members also play an integral role in planning for future growth, have the ability to attend our regional conferences, and support the financial stability of the organization.

Here’s the corporate membership roster of the Council – Digene (makes the HPV test), Merck (HPV vaccine maker), GlaxoSmithKline (HPV Vaccine maker), Wellpoint (heads the council), Exxon Mobile and Verizon. A full 50% of the membership stands to benefit from the legislative efforts of the Challenge to Eliminate Cervical Cancer. And one of the Council’s members, Digene, has a bit of a sordid past when it comes to partnering with women’s groups to forward favorable legislation.

Digene and the European Women for HPV

In 2004, a group called The European Women for HPV Testing began to campaign for legislation in England for national HPV screening. High profile female celebrities were recruited to the group to be spokespersons for the group and to lobby for legislation to approve the HPV test as primary cervical cancer screening. The European women for HPV Testing group even got mentioned in the British Medical Journal, in a manner similar to the NEJM mention of the WIG.

The problem was, the European Women for HPV Testing did not actually exist. As revealed by the Guardian Observer, the “group” was actually a front organization created on paper by the advertising company Burson-Marsteller and entirely funded by, you guessed it – Digene.

Partners with Aligned Interests?

Digene makes no bones about its strategy, which, according to their 2006 annual report, is to “expand beyond published data and medical guidelines to change the way healthcare is practiced“.

The WIG makes no bones that its strategy for tackling the issue of cervical cancer is “a collaborative approach… enlisting the support of stakeholders from across the globe” in its efforts. In their most recent report, the Challenge to Eliminate Cervical Cancer clearly stated that the publication was made possible by funding from Digene. But on none of its press releases about HPV does the WIG reveal its relationships with Digene, Merck or GlaxoSmithKline.

One could argue that without such funding relationships, the agenda of the WIG could not be forwarded. One could argue that in the case of cervical cancer, the interests of women and those of Big Pharma are aligned. One could argue that without Big Pharma to fund it, the Challenge to Eliminate Cervical Cancer would be nothing more than a nice name for a good cause.

But one could also ask whether the Challenge to Eliminate Cervical Cancer would even exist without Big Pharma. Both Merck and Glaxo have used PR firms to create advocacy groups whose mission is to increase awareness of HPV, and who “partner” with existing health and women’s advocacy groups. One is called The Partnership to End Cervical Cancer, and the other (which now appears defunct) is called Make the Connection.

And one could also argue that the financial ties between the WIG and Big Pharma puts the WIG in the position of being a lobbyist for Big Pharma rather than being political advocates for women.

Update on this issue here.
_____________________________________________
Disclaimer: I use the HPV test in my clinical practice, although only for ASCUS triage and not for routine screening. I have not yet given the HPV vaccine to any patient, although we are discussing it, and given the recent recommmendations of the immune practices committee of the CDC, I expect I will be giving it. I still have a lot of concerns about the high cost of the vaccine, how long immunity will last, what will happen when the next generation of vaccines hits the market, and if it will really make a difference in the health of my patients, who for the most part, recieve regular pap smear screening.

Both the speed and sense of urgency accompanying the recent movement of the HPV test and vaccine into the healthcare arena has been startling to me, and I believe heralds a new age of unprecendented pharmaceutical marketing and influence. Physicians, patients and yes, even lawmakers need to be aware of these new strategies that are being used to influence us.

Category: Second Opinions

11 Responses to Big Pharma and Women in Government – Partnering for HPV Legislation

  1. Thank you so much for documenting what has seemed screamingly obvious to me: cervical cancer is not an enormous health issue for women in the developed world. Fewer than 10,000 cases were projected to be diagnosed in the US in 2006, with fewer than 4000 deaths — essentially all in women who never got paps. The paradox is that the women who are asking us about the vaccine are never going to get cancer. (Arguably the vaccine will decrease the number of abnormal paps and the attendant follow up costs, both financial and emotional, but the evidence is not there.)

    Africa is another story, where cervical cancer is an epidemic tragedy. (So is polio, but I have to get back to Flea on that.) As I’ve said before, if Merck were to donate one dose to Africa for every dose sold here, I’d be lining them up!

  2. Dinosaur –
    Cervical cancer is a big health issue as far as I am concerned, and even 1 death is too many, and I will be offering the vaccine in my practice.

    What concerns me, though, is how this marketing and advocacy campaign represents the new approach that pharmacetical companies and healthcare manufacturers are using to influence the rapid adoption of new drugs into clinical care. The role of the healthcare profession itself is being eroded by those with enormous financial stakes in the outcomes. The direct to consumer marketing and creation of advocacy has already taken us out of the loop. The rapid expansion of the numbers of so-called health care “thinktanks” that are nothing more than marketing arms for pharmaceutical companies is similarly alarming. Everone is focusing on the conflict of interests of doctors – in dollar terms, that is pennies compared with what is really going on out there in terms of conflicts.

    At the same time, it is clear that this kind of aggressive marketing can be used for the public good. I wonder if they had done this when the heatitis B vaccine came out, we would have had more widespread use of this vaccine.

  3. While I can appreciate the fear of having advocate groups and pharma companies driving this initiative into the medical community, at least they are making serious progress. Are they motivated by money – yep! Isn’t hospital adminstration too? No one is immune…

    Pharma may have an agenda, but, to be VERY frank, they have done more for educating the public about HPV in one year then than the medical community has since knowing the linkage of HPV to cervical anomolies. I don’t see you giving them credit in this regard at all.

    I admit that I am in the pharma industry, so my opinion is bias, but when Merck did the market research to find out what the awareness levels were in the USA regarding HPV, they were shockingly low. I don’t have the statistics in front of me, but even women receiving regular paps did not know why they had to get them, and that cervical anomolies are laregely due to the virus. A virus which the CDC thinks is present in as much as 70% of the sexually active population of the USA. 70 frickin %!

    Also, I absolutely go crazy when I read notes like, “if Merck were to donate vaccine to Africa…” Comments like this show a clear lack of understanding of what it takes to get a drug to market. Are they profitable? Yep! So is Exxon. A whole lot more profitable. So is Wall Street…16 BILLION in just BONUSES this year. That is bigger in payout than the VAST MAJORITY of pharma companies are in GROSS SALES!!!!!!!!! Where’s your outrage towards them?

    Is it horrific that people are dying from cervical cancer and other conditions like AIDS? Of course it is. Is it the obligation of the American private sector to solve the world’s problems? I don’t think so. Particularly since the cultural and social ramifications of treatment of conditions like cervical cancer and AIDS are far more difficult to overcome then getting drug into their hands. I guess it all comes down to entitlement. Why do people think that they are entitled to get the best care in the world at all times under all conditions? Not sure…

    The point about the future generations of vaccines is an interesting point that I think is reasonable to have cause for concern. Is the next version going to cover more strains of the virus? Men? If so, can we have both? Good questions..

    As for now, it would be great to hear the people who fight this virus on a daily basis applaud the people in the world who have found a way to avoid the fight and prevent cancer. THAT would be nice.

    By the way, go seek out the data from the clinical trial for the Merck vaccine. It was one of the most successful trials in FDA history…

    I am not advocating that universal application be implemented. However, the fact that the government sees the opportunity to further protect women’s health is a good thing.

    Lastly, is the vaccine expensive? Not sure since 1.) my insurance will (Thank God, and yes, I know how fortunate I am.) cover it, and 2.) I am a man, and 3.) my daughter is only 4 and my wife and I are getting older and monogamous so she isn’t a necessary candidate. But this is just the latest “technology”. Do you pay for the auto-parking Lexus through the nose? I think so…if the new technology is too expensive for the indivisual, then the standard pap testing is still there, and so is the colposcopy, and the LEEP procedure, and the chemo and the surgery….

  4. Schtrugglin’ –

    Always good to hear from the Pharma side. 🙂

    If this were a one-sided issue, it would be and easy one. Of course a vaccine against cervical cancer is a good idea. Of course Big Pharma has done loads of good in the world – Most of my day is spent prescribing one drug or another, and I would be pretty ineffective physician without them. If it will make you feel better, I will do a post thanking Big Pharma for all they do.

    But there is nothing wrong with understanding how the marketing process works, is there? Or in pointing out the various sides of the argument? (Which I believe I did in my post)Or in knowing whose message we are getting?

    By the way, I believe the statistic is that 70% of Americans had had HPV at some point, not that 70% of us are walking around currently infected. It sounds shocking, I know, but then again I bet more than that many of us have had a strep throat (or two) in our lives. The important point is that almost all of these infections are self-limited and ultimately cleared.

  5. Once again, thank you. You do a great service in pointing out how the pharma industry now operates. Meds have saved countless lives and many of us (including me) wouldn’t be here today without them. However, there are issues to be discussed as you so cogently point out. I, for one, don’t feel comfortable about how some of these companies have operated, particularly Merck. Recents events have eroded the public’s confidence in these companies as well as in the FDA.

  6. I feel that TBTAM is respectfully asking that patients be allowed to be informed consumers of medical information rather than frightened into requesting tests, vaccines, drugs or specific courses of therapy.

    As a patient, I appreciate that. Don’t scare the shit out of me such that I run to my doc making requests based on a corporate marketing plan. Trust that I’m intelligent and intuitive enough to take the information and have an informed conversation with my doctor. Trust that my doctor is intelligent and intuitive enough to use the information along with my specific medical and social history to recommend a course of action.

    Maybe I’m missing something here, but that’s what I think when I read TBTAM’s posts. Big Pharma has every right to use television to market their products, but considering that TV is used by all sectors of business to shame and frighten women into “needing” something that’s out there, and, well, I think it’s healthy that TBTAM is picking apart their marketing tactics. It makes us all better consumers of information and better able to care for our bodies.

    Big pharma – keep up the good work. Keep developing medicines and tests for us to get and stay healthy. TBTAM keep keeping them on their toes. This consumer of information greatly appreciates it.

  7. Why are there no vaccines for the male population? Females do not get the virus by themselves. I guess our female children are expendable. There are all over the internet many articles which describe the dangers associated with this particular vaccine. Of course, as usual, this is probably a requirement limited to children who attend public school, and those in private schools need not worry. I find this plan very disgusting.

  8. Dear Doctor,

    You have stated your concerns re: the HPV vaccine, but still intend to give it to your patients? I do not understand. The decision is a simple NO. Please do not injecct young women with a vaccine produced by the same company, Merck, who marketed the dangerous drug Vioxx which killed 50,000 people according to FDA whistleblower David Graham (he said this to the Senate subcommittee investigating drug safety) Two years ago Graham said, “the FDA cannot protect the American people as it is presently configured” and recently he said nothing has changed at the FDA.

  9. This is so important–thanks for researching and writing it. The word is now, months later, starting to get out: Judith Siers-Poissons has a 4-part series on “The Politics and PR of Cervical Cancer” at
    http://prwatch.org/node/6232. But even as I delight in the corruption behind WIG being exposed, I worry that the cynicsm that will be generated as women learn about this sort of manipulative, profiteering skullduggery will deepen the pervasive distrust of science and medicine, fuel pseudoscience, and inhibit women from becoming active around other sexual and reproducive health issues in the future.

  10. I get so tired of articles like this that bash pharmaceutical companies. Please remember that without them, you can't do your job. You are nothing more than a diagnostician.

    You can tell the patient what is wrong with them all day, but without the pharmaceutical companies, you are powerless to do anything about it. You cannot treat anything without the medications they make unless, of course, you do surgery. And even then, you need their medications.

    I, for one, am thrilled that when I walk into my doctors office, there is a whole closet full of medicines for them to choose from that usually will treat whatever issue is going on, many of them in an amazingly short amount of time. Even for the slightest little complaint like a runny nose or allergies.

    I don't work for a pharmaceutical company, I'm just incredibly thankful that they exist. Why aren't you?

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.