Johnson & Johnson Recalls Mylanta

What is going on at Johnson & Johnson? The pharmaceutical manufacturer has issued yet another recall. On December 2, CNN reported that the company recalled over 12 million bottles of the antacid Mylanta and more than 84,000 bottles of AlternaGel, a medication for heartburn relief. The recall was due to the fact that alcohol from flavoring agents was not listed on the products’ packaging. Johnson & Johnson officials said it is unlikely that the recalled products will cause either “alcohol absorption or alcohol sensitivity-related adverse events.” The recall was initiated so that the company could add the information to the label.  

photo

This recall comes just weeks after the company recalled millions of packages of Benadryl, Motrin, and Rolaids on November 15.  See this blog post by our very own Roxanna Tabatabaeepour for more information about that recall. In October, Johnson & Johnson recalled several over-the-counter drugs, including Tylenol, Motrin, and Benadryl, due to an “unusual moldy, musty, or mildew-like” odor. The company also issued a recall in late 2009 for certain varieties of Tylenol.  For a more complete list of recent Johnson & Johnson recalls see this blog post. A complete list of the lot numbers affected by the current recall can be found here.   

Would these recalls make you think twice about purchasing Johnson & Johnson products in the future? They certainly raise some serious questions about quality control at the company. But Johnson & Johnson has been making drugs like Tylenol for decades. Is there enough history of quality there to overlook the company’s recent problems? 

Darvon and Darvocet Pulled from the Market

Prescription painkillers Darvon and Darvocet were pulled from the market Friday by their manufacturer, Xanodyne Pharmaceuticals, Inc. According to a report from CNN, Xanodyne reportedly pulled the drugs at the request of the Food and Drug Administration. Darvon is the brand name for the drug propoxyphene, and Darvocet is a brand name for propoxyphene mixed with acetaminophen.  Darvon and Darvocet have been approved for use since 1957, but officials at the FDA now believe the risks of using the drugs outweigh the benefits. The medications, which have been prescribed for 10 million people since 2009, can cause serious heart rhythm abnormalities that could potentially be fatal. Generic forms of the drugs are still available, but the FDA has asked manufacturers to stop selling them and recommended that physicians stop prescribing them.  

photo

Controversy has surrounded propoxyphene for some time. According to an article in the Washington Post, Britain pulled the drug off the market six years ago, and Europe pulled it more than a year ago. Public Citizen’s Health Research Group has been calling for the U.S. to remove the drug for some time. In a statement issued on Friday, the group said that 1,000 to 2,000 people in the United States have died because of the drug since the United Kingdom banned it.

Patients have been advised not to stop taking it, but instead contact their doctors. Some have pointed out that stopping abruptly can cause withdrawal symptoms. For those that need to take painkillers, there are still plenty of other options out there. Consult your doctor on which one is right for you.

Fosamax Trial Highlights Problems with Bone Medications

The latest trial dealing with the drug Fosamax is highlighting some of the risks of medications designed to treat osteoporosis. The New York Times reported on November 10, that the latest trial involving a plaintiff allegedly injured by the pharmaceutical drug Fosamax is underway in New York City. The plaintiff in the latest case is Judith Graves, a 67-year-old retired investigator for the United States Army. After taking Fosamax, Graves suffered jawbone death, a condition that involves debilitating jawbone deterioration. She had to have five operations, eventually having her jaw replaced with bone from her left arm.

Graves says Fosamax is to blame for her jaw troubles. Fosamax is an oral bisphosphonate manufactured by Merck. The drug is designed to prevent bone mass deterioration caused by aging. Graves’s case is one of several test cases against Merck that is being tried. There are roughly 1,400 other cases against Merck alleging injuries caused by Fosamax. Two test cases have already been tried, with Merck winning one and the plaintiff winning a multimillion dollar judgment in the other. We have filed cases on behalf of people injured by the drug. 

It is unclear how the Graves case will turn out, but as the New York Times reports, the case is serving as a backdrop for a larger debate about the proper use of oral bisphosphonates. Although the drugs have been shown to be effective in reducing bone fractures in postmenopausal women with osteoporosis, many doctors are concerned about the risks of prescribing them for too long. The Food and Drug Administration now requires the labels on Fosamax, Actonel, Boniva, Reclast, Atelvia, and generic versions, to state that the optimal period of use of these drugs is unknown. The fear is that long-term use of the drugs could cause not only jawbone deterioration but also thigh fractures. And for many these risks outweigh the benefits of prescribing the drug to women who have not yet developed osteoporosis. Others have commented on the dilemma this poses for doctors.

This trial underscores how important it is for patients on oral bisphosphonates to discuss the risks of these drugs with their doctors. Although they have saved people from the aggravation of broken bones, they carry considerable risks as well.

"Dollars for Docs" Database Sheds Light on Pharmaceutical Promotions

Have you ever wondered if your doctor has ulterior motives in prescribing you a certain medication? Now you have a way of finding out if your doctor is being paid to promote certain drugs. 

Last month ProPublica launched its Dollars for Docs database, which compiles data about payments pharmaceutical companies have made to doctors for promoting their drugs. According to ProPublica, pharmaceutical companies routinely pay doctors to give presentations designed to teach other doctors about the benefits and risks of their drugs. In 2009, seven drug companies began disclosing information about these payments. ProPublica compiled this data, which totals $258 million in payments, into a searchable database. 

 

The website has also launched a series of articles analyzing the information in the database. They have already posted stories on paid presenters that have blemished records and limited credentials, and a breakdown of which doctors have received the most money from the pharmaceutical companies in the last couple of years. Although the database only covers payments made by a fraction of the total number of pharmaceutical companies, it still sheds some light on the process by which doctors learn about drugs and decide which ones to prescribe. It is also a way for patients to find out if their doctor may have a conflict of interest when it comes to writing certain prescriptions. As the ProPublica site points out, there is not necessarily anything wrong with doctors being paid to promote certain drugs, but it does raise ethical questions. The website has also posted a guide for patients on how to use the database, and what it means if their doctor has received money.

 

The database already has some calling for increased transparency in the world of pharmaceutical drug promotion.

Avanir Makes Laughing and Crying a Thing of the Past

Ever wonder how to get rid of that pesky crying and laughing that was wearing out your facial muscles? Well you don’t need to wonder anymore, Avanir Pharmaceuticals has  developed a drug that was approved by the FDA on October 29, 2010 that will treat that condition.   Hopefully the sarcasm is obvious.

The drug is called Nuedexta and it will be used to treat patients who develop symptoms known as the pseudobulbar effect, which can usually be found in patients with neurological disorders and brain injuries.  The pseudobulbar effect has been called emotional incontinence where one has no control over laughter or tears. Sounds like a fake problem , well Avanir thought so and they unsuccessfully tried to change the name of the condition to involuntary emotional expression disorder.  

Not to take anything away from patients who suffer from something like this but when did it become the norm to treat “conditions” that are essentially harmless and out of one’s control. I mean, this drug is going to be marketed to people with serious underlying medical conditions to treat an uncontrollable action that poses no serious health risks.  Besides being driven by the profits that could be made from targeting this population, what other incentive would the pharmaceutical company have? I understand that uncontrollable crying or laughter may have an impact on ones social life or lead to embarrassment but is that outweighed by the known cardiac and hepatitis risks associated with taking the drug?

I previously wrote about the “condition”  that women go through and how pharmaceutical companies have found a way to help cure us. This too reminds me of how big pharma will find a way to help us deal with all of the “conditions” we may go through or “suffer” from in life. Is uncontrollable laughing a serious health risk, not really, but how about if there is a medication out there to treat it? Then people start looking at it as more than just an inconvenience, and now it is a condition that can be treated.  Perhaps one day prescriptions will only be used to treat serious ailments or at least provide measurable health benefits to the users……but I wouldn’t hold my breath.

A New Era: Limiting the Preemption Doctrine

The Supreme Court’s decision in Wyeth v. Levine, 129 S. Ct. 1187 (U.S. 2009), represents a victory for consumer advocates and a change in tide within the preemption debate. On March 4, 2009, the Court found Wyeth, the pharmaceutical giant, liable for the adverse affects of one of its drugs. Phenergan, which is administered intravenously to treat migraine-induced nausea, caused plaintiff Levine to suffer the amputation of her arm after an “IV push” injection of the drug caused irreversible gangrene. Wyeth argued that the Food and Drug Administration’s (“FDA”) regulations preempted Levine’s lawsuit, but the Court disagreed. 

The Court expressly rejected Wyeth’s preemption argument for two reasons: (1) state law claims did not obstruct the FDA’s authority to regulate drug labeling; and (2) the evidence actually suggested that Wyeth had long ignored reports showing the dangers of injecting the drug using the IV push method. In fact, the Court observed that Wyeth could have “analyzed the accumulating data and added a stronger warning about IV push administration of the drug.” The Court also rejected Wyeth’s companion arguments, which spouted the impossibilities of complying with both state law and the FDA’s regulatory scheme and the danger of allowing a “lay jury’s decision about drug labeling” act as a substitute for the “expert judgment of the FDA.”

The Court’s decision was welcomed by consumer advocates who previously feared that pharmaceutical companies like Wyeth would be insulated from liability, especially given the Bush Administration’s expansive view of preemption. Following the Wyeth decision, President Obama made his narrowed view of preemption known when the White House released a memorandum on the subject. On May 20, 2009, President Obama asked heads of agencies and departments to reevaluate their preemption policies, advising them only to issue preemptive statements “if [they are] supported by sufficient legal principles.” President Obama’s memorandum symbolizes a return to traditional federalist ideals, emphasizing the importance of state laws and the ways in which they work in tandem with federal laws to create safeguards for the public. 

In the months following Wyeth, advocates on both sides of the preemption debate have spoken out. Those in favor of preemption call the Wyeth decision “catastrophic” for patients and doctors.   They foresee an insurmountable stall on new drugs entering the market; new drugs that could help combat serious illnesses like cancer and HIV/AIDS. Other analysts are shocked that this medical malpractice case reached the Supreme Court at all, let alone resulted in a lay jury determining the adequacy of a federal agency’s regulatory scheme. Consumer advocates, on the other hand, view the decision as a triumph for the little guy, meaning consumers like Levine. . However, both sides agree on one thing: consumers will test the durability of the Wyeth decision to see just how much liability pharmaceutical companies will bear in the future. 

In any case, Wyeth is not the last time we will see the preemption issue under scrutiny. But, for now, consumer advocates and victims of pharmaceutical drug companies can relish in this victory and rest assured that they have preserved their right to hold pharmaceutical companies accountable in court.