Get back in rhythm: just not with Multaq

Did you know September is AFib awareness month?

As a believer in education as the first, and best treatment of AF, I think it’s great to enhance the public knowledge of this highly-misunderstood disease.

By all means…

Tell people about AF’s risks: stroke and heart failure.

Tell them that their fatigue, poor exercise tolerance and breathlessness might not be old age; it might be AF.

Tell them about the importance of early intervention.

Tell them that obesity, inactivity, sleep disturbances, alcohol, and incessantly worrying about everything makes AF more likely to occur, and to stay.

Tell them that there are specialists that spend almost their entire day (minus the time it takes for paperwork, clicking the e-chart and doing time-outs) treating AF. We are called electrophysiologists.

You could even enroll a celebrity to the cause–as no one wants to hear from masters-aged endurance athletes who have inflamed their atria to the point of quivering.

Yes. By all means, get Barry Manilow to tell his AF story. Put it on a flashy website and call it  GetBackInRhythm.com.

Oh, the irony. It seems Mr Manilow is advocating a rhythm-control strategy for AF. That’s reasonable. The problem here, my friends, is that he is partnered with Sanofi, makers of the expensive, poorly-tolerated, ineffective and embarrassingly over-hyped drug, Multaq. I’ve said it before, but I guess it has to be said again: Multaq simply doesn’t work to control AF. Nearly everybody that isn’t paid by Sanofi admits this.

What inflames me most about Sanofi’s refusal to curtail the egregiousness of promoting Multaq is that it gives everyone in this business a black eye. Critics of industry involvement with doctors point to the Multaq debacle. They say this: (my translation)

Hey…Sanofi pays for clinical trials rigged to make the drug look better (they use surrogate, composite endpoints, like hospitalizations; not AF control). Then they pay academic leaders to tout the drug. It turns out that these same leaders also write the guidelines, so it’s little surprise that Multaq gets written prominently in the AF treatment algorithm.

Call me naive, but I strongly disagree with those that argue that Sanofi’s boondoggle (with Multaq) is the rule with industry involvement in medicine. Modern medicine is where it is today due to the innovation–and marketing–of proprietary therapies. Life-saving medicines like ACE-inhibitors, Beta blockers and Statins were all once highly-touted branded drugs. (Ask my ICD patients that keep on trucking year after year about the benefits of these medicines.) Their makers paid thought leaders to educate, and to promote a drug that helped many more than it hurt.

This paradigm is still the rule that I see in the real world. The most recent example of such symbiosis is Boerhinger-Ingelheim’s Pradaxa–a highly-marketed, yet highly-effective medicine.

Hopefully this will be my last Multaq post.

But somehow I doubt it.

Why can’t I get the word futility out of my head?

JMM