Canadian Doctors Cautious On Cholesterol Drug

U.S. doctors have been quick to prescribe Ezetimibe, a powerful new drug to lower cholesterol. Canadian doctors have been taking a "wait and see" attitude because there's no evidence that the drug can effectively reverse heart disease like cholesterol-lowering statins can.

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New details about the effectiveness of a popular new cholesterol-lowering drug have come out at a meeting of cardiologists in Chicago. The drug doesn't appear to do much good in controlling hardening of the arteries. That may cause doctors to think twice before prescribing it.

NPR's Joanne Silberner reports on a cultural twist to the story. Another new study shows that physicians in the U.S. have been much more likely to prescribe the new drug than physicians in Canada.

JOANNE SILBERNER: The new drug is Ezetimibe. It's an active ingredient in two products, Zetia and Vytorin. It's made by Merck and Schering-Plough, and it lowers blood cholesterol better than the statin drugs, says cardiologist Harlan Krumholz of the Yale University.

Dr. HARLAN KRUMHOLZ (Cardiologist, Yale University): Well, we don't really know what the effect is on people's lives on preventing heart disease, on improving survival.

SILBERNER: Statins, on the other hand, have been shown to reverse heart disease and cut the death rate. American and Canadian guidelines call for trying statins first, and then trying the Ezetimibe only if the statin drug doesn't lower cholesterol enough. But some U.S. doctors began using Ezetimibe as a first choice, Krumholz says.

Dr. KRUMHOLZ: What we found in the study was that the adoption unit in the United States was much, much faster than it was in Canada. We had a rapid increase in the use of this drug, and there was really no comparison.

SILBERNER: In 2006, U.S. physicians prescribed the Ezetimibe drugs five times as frequently as Canadian physicians, Krumholz and other researchers report in the online edition of the New England Journal of Medicine. One reason for the difference in prescribing habits? Maybe marketing. The Canadian government prohibits direct-to-consumer advertising. The manufacturers won't say, but one study claims $200 million was spent on advertising Zetia in 2006 in the U.S. Plus, Krumholz says, every time he open the medical journal or went to a meeting, he saw an ad.

Dr. KRUMHOLZ: Physicians in both countries are trying to do their best for patients, but if you get inundated with marketing, your patients get the marketing and you get the marketing and there's a big push on this, I think that we're susceptible to the next new thing.

SILBERNER: Canada didn't approve Zetia until seven months after the U.S. and it still hasn't approved Vytorian. Cynthia Jackevicius is Canadian. She was one of the authors of the study that Krumholz worked on, and she says, cultural differences may be at work.

Professor CYNTHIA JACKEVICIUS (Assistant Professor, Associate SGS Member): With the United States tending to be more assertive, you know, wanting the latest thing in using (unintelligible) more quickly and the idea of growth being so important.

SILBERNER: She says there is a downside to it: the lack of availability of some drugs in Canada can be frustrating. But there's a cost attached for the U.S. The researchers calculated that if U.S. physicians have prescribed the Ezetimibe drugs at the lower rate the Canadian physicians prescribed them, the savings would have been $1.5 billion to $2 billion in 2006. Meanwhile, there's a trial to determine if the cost and the marketing of the Ezetimibe drugs are for the public good. It will count how many people in Ezetimibe avoid heart attacks and how long they lived. Editors of the New England Journal of Medicine note that the results of that trial aren't due until 2011 at the earliest.

Joanne Silberner, NPR News.

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