Wednesday, August 08, 2012

Is Type 2 Diabetes Drug Marketing Responsible for Misdiagnosis of Type 1 Diabetics?

A Wall Street Journal article documents several cases of people being misdiagnosed by general practitioners as having Type 2 diabetes when they actually have Type 1 diabetes, "a substantially different condition" (see "Wrong Call: The Trouble Diagnosing Diabetes"). According to the article:

"An incorrect diagnosis usually occurs in the offices of primary-care doctors, many of whom haven't received adequate education in medical school about rising rates of Type 1 in adults and how to diagnose it. 'It is not on their radar because they see so much diabetes and it is by far mostly Type 2,' said Irl B. Hirsch, professor of medicine at the University of Washington Medical Center in Seattle."

As I continued reading, I couldn't help but wonder if the current competition among drug companies to sell Type 2 diabetes drugs has something to do with this. Fierce marketing of these drugs - see box below - may be contributing to emphasizing Type 2 diabetes on GP's "radar screens."

The Three Type 2 Diabetes Drug "Amigos"
  1. Januvia - marketed by Merck
  2. Onglyza - marketed by Bristol-Myers Squibb/Astrazeneca
  3. Victoza - marketed by Novo Nordisk
See "Three Companies Compete for Diabetes Market Share"

In each case cited in the article, misdiagnosed patients were taking oral drugs, none of which were mentioned by name, and none of which are effective or approved by the FDA for treating Type 1 diabetes. "For six years, Mr. Jones [a patient] treated what had been diagnosed as Type 2 diabetes. He changed his diet and took three oral medications daily." It's likely that at least one of those drugs was one of the "Three Type 2 Diabetes Drug 'Amigos'" mentioned above.

Of course, many GPs would probably misdiagnose patients as having Type 2 diabetes when they actually have Type 1 diabetes even without being bombarded with marketing for Type 2 treatments. But having multiple pills available to prescribe makes it easier, in my opinion, to avoid taking the patient down the path to a possible Type 1 diagnosis.

The ultimate responsibility for misdiagnosis, however, must rest with the physician and not the pharmaceutical marketer, unless of course, the marketer offers physicians inducements (ie, money or non-monetary rewards) for prescribing products.

On that note, I also read a story in today's WSJ about Pfizer and other drug companies bribing doctors to prescribe their drugs. Pfizer settled with the DOJ -- admitting nothing -- but paid $60.2 Million to "Resolve U.S. Allegations That It Used Illegal Payoffs to Win Business Overseas."

Of course, such things do NOT happen here in the U.S.

2 comments:

  1. As you say, mis-diagnosis of any disease is ultimately the docs fault. It's nice to read someone more cynical than me. Keep up the good work!

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  2. There are relatively well-known diagnostic tests for autoantibodies including Islet Cell Cytoplasmic Autoantibodies (ICA); Insulin Autoantibodies (IAA); Glutamic Acid Decarboxylase Autoantibodies (GADA); GAD65 Autoantibodies; Insulinoma-Associated-2 Autoantibodies; IA-2A; ICA512 Autoantibodies which can confirm autoimmune type 1 diabetes. Even without tests for these, a very common C-Peptide test done by virtually any commercial laboratory around can measure the amount of endogenous insulin production is present; typically people with type 1 will have none or miniscule amounts, whereas people with type 2 will have normal or even higher-than-normal C-Peptide counts (at least at the time of diagnosis). Any physician who fails to run these tests is indeed at fault, and many could be guilty of age bias (meaning if the patient is not a pediatric, they automatically presume it is type 2 diabetes).

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