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R.I.P. Xigris


Eli Lily's drug Xigris (rhAPC), introduced ten years ago, has been withdrawn from the market as of last week, following completion of a new study that, according to a Lily spokesman, “failed to demonstrate that Xigris improved patient survival and thus calls into question the benefit-risk profile of Xigris and its continued use."

No, this is not a Business Week or CNBC blog, but this drug has had a stink on it for its entire existence from my admittedly limited perspective, and it's worth exploring a little bit for larger lessons in its story.

When I was in training, we all loved the drug reps, the money being thrown around, the dinners and parties, the free samples, all of it. ("Scrubs" nailed it pretty well, I thought.) When I started practice, I still liked it, and it was better in some ways - you could get paid to give talks at really expensive restaurants. Heck, some people got flown to resorts or swanky hotels. I even did a little of that.

Xigris was the beginning of the end of all that for me. It was clear from the beginning that this drug was going to be pushed and pushed hard. From my little corner of the world, I could see it in the over the top marketing by the local sales force, the mailings from my specialty societies, and most of all, the amazing amount of money being lavished on the societies at the annual meetings.

As detailed in a refreshingly blunt NEJM article in 2006, Lily had hired a marketing firm and developed a strategy:

First, the product's sales were to be supported by marketing initiatives targeted to physicians and the medical trade media. Second, because rhAPC was relatively expensive, word would be spread that the drug was being rationed and physicians were being “systematically forced” to decide who would live and who would die. As part of this effort, Lilly provided a group of physicians and bioethicists with a $1.8 million grant to form the Values, Ethics, and Rationing in Critical Care (VERICC) Task Force, purportedly to address ethical issues raised by rationing in the intensive care unit. Finally, the Surviving Sepsis Campaign was established, in theory to raise awareness of severe sepsis and generate momentum toward the development of treatment guidelines.

"Relatively expensive" seems kind phrasing, even in the ICU, where we spend a lot of money. At nearly $7000 a pop, it was destined to bust many a hospital pharmacy budget in a world where payment is based on DRGs and there was no extra money for Xigris. In what I will kindly call a miracle, CMS (Medicare) developed new codes to provide an add on payment to cover half the cost of a treatment - while simultaneously reducing funding elsewhere in Medicare's budget to offset the cost.

It was at this point that I had finally had enough. It was all just too much. The influence of money on my profession, my specialty societies, and my government were not something I could ignore any longer. I cut off relationships with all drug companies. I see no reps, attend no dinners with a lecture on the side, and give no lectures for them either. I pushed my hospital CME committee to end pharmaceutical sponsorship.

I have been pleased to see major medical centers stepping up as well. If you are not aware, there is also an organization called "No Free Lunch" that helps us wean ourselves off of "drug money." Now if we could do the same for Congress...

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