play book, the government has announced that it has started a program designed to encourage physicans to use more diuretics. This detailing effort was launched, in part, to counter marketing efforts by pharmaceutical companies manufacturing more expensive high blood pressure medications.
The 3-year, $3.7 million program was designed by the National Heart, Lung and Blood Institute (NHLBI). Its objective is to educate physicians on the results of the controversial Anti-hypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). The government has argued that the trial results suggest that inexpensive "water pills" (diuretics) are just as effective as more expensive high blood pressure medications.
Some hypertension experts, however have criticized the trial, suggesting that the results are not as clear cut. For example, noted high blood pressure expert Dr. Michael Weber has said that the ALLHAT conclusions are "debatable at best." He noted that the trial failed to demonstrate that diuretics prevent fatal heart attacks better than other medications tested in the trial. In addition, others observed that the diuretics may have appeared better at preventing strokes because African Americans taking another type of blod pressure pill, ACE inhibitors, suffered from more strokes than whites enrolled in the trial.
Dr. Weber has also criticised the government's marketing campaign, suggesting that it may ultimately embarass the NHLBI. He has suggested that physician "drug reps" will be allowed to make claims about diuretics that are not supported by the facts.
Why This Matters
The government's diuretic marketing effort matters because it represents a signifcant change in its attempts to influence practice patterns. Rather than simply conducting a trial and releasing the results, the goverment is using marketing methods honed by the pharmaceutical industry to shift physicians perceptions.
The goverment will have a tough time influencing high blood pressure management using ALLHAT because physicans doubt the study. There is also the issue of numbers. The goverment is fielding a "sales force" of a few hundred physicans versus pharma's tens of thousands.
It will be interesting to see whether the goverment's effort has a measurable influence on practice patterns. However, I'm sure that the ALLHAT trial's promoters wish that the trial was not so controversial. When a trial does not clearly answer the question it was designed to address, it's tough to get people to accept it.
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