Dr. Joan Bushwell's Chimpanzee Refuge

Let’s see, the Biz shot its right foot with the Vioxx debacle, then its left foot with Zyprexa (and others, but that’s a recent one), so now it must look for another site for further damage of its tattered n’ shattered image. Hmmm, how about lobbing off a couple of fingers? The FDA’s approval of Slentrol, Pfizer’s new chemical entity (NCE) for treatment of obese dogs ought to do the trick. Zing! There go the fingers.

As a minion of the dark overlords, I have to say that the announcement made me cringe for a number of reasons, the primary one being that this further solidifies the perception that “all drugs from pharma are for frivolous indications.” This past weekend, I visited a close friend, a sr. director of chemistry of a company in the Boston area, and we lamented this latest flappery not only for the bad PR, but also because of its sheer lack of necessity. After all, a typical American dog’s diet is in the control of its owner; likewise, so is its level of activity. Jeez, people. Just take the dog and yourself out for a walk.

The subject has been covered by other Science Bloggers. See effect measure, Corpus callosum, and Retrospectacle. I’ve already made my opinions on drugs for human obesity known (And now a word from obesity’s big fat corporate sponsor), but that won’t stop me from weighing in (har) on fat doggies and Pfizer’s strategy.

Now Shelley’s post in Retrospectacle is a fine screed, but if one is to speak of “the truth” regarding Pfizer’s NCE for canines, then the following “despite it seeming to fill an non-existent market” is not quite accurate.


In fact, fat dogs are an existing market, and given what Americans are willing to spend on their beloved pets, a very lucrative one. Pfizer’s marketing machine must have eyed the market hungrily. From the FDA press release

“This is a welcome addition to animal therapies, because dog obesity appears to be increasing,” said Stephen Sundlof, D.V.M., Ph.D., director of FDA’s Center for Veterinary Medicine. “Veterinarians are well aware that overweight pets are at a higher risk of developing various health problems, from cardiovascular conditions to diabetes to joint problems.”

Veterinarians generally define a dog that weighs 20 percent more than its ideal weight as obese. Surveys have found that approximately 5 percent of dogs in the United States are obese, and another 20-30 percent are overweight.

There are a lot of pet dogs in the United States. Even if the 61 million figure in the link is off by a hundred thousand or so, 5% of that is still a high number of portly pooches. That’s around 3 million fat and pampered dogs. Hence, “The Market.”

If Pfizer’s formidable marketing machine didn’t survey the landscape for possibility of profits, they would not be doing their job. Although the cost of developing Slentrol is less than that for an equivalent for humans (oh, those pesky clinical trials), it’s pretty darned unlikely they would have forged ahead if there was a “non-existent market.” I mean, look at the large number of people afflicted with malaria, dengue fever, and Chagas disease. The organisms which cause these diseases harbor potentially tasty targets for small molecule drugs, but in spite of the number of patients, there’s “no market,” i.e., a largely impoverished population of patients. They are deemed lower in priority than the many wealthy (relative to msot who have Chagas disease) pet owners who will buy into the ads. Contrast that with the American market which is more than willing to spend a lot of money on so-called “lifestyle drugs” for themselves. Yes, Big Pharma will eagerly expand markets beyond “need” through plenty of advertising and sales calls, but it does not createthe market. The fat dogs, fat people, slack willies, and balding pates (re: Propecia) of the American populace are the market for the drugs decried as “medically unnecessary.”.

It’s not only the patent expirations of Pfizer’s big sellers which have this behemoth of a company scrambling. Pfizer had high hopes for torcetrapib, the cholesterol ester transfer protein inhibitor, which was in line to replace Lipitor. Torcetrapib went belly-up in clinical trials. Derek Lowe covered this nicely in his article, The Torcetrapib Catastrophe. This is recommended…no, make that required reading. Anyway, so long, torcetrapib, hello Slentrol!

Who knows what all is in Pfizer’s early stage pipeline? Well, the Pfizer researchers know, and my best guess is that there probably are some genuinely innovative compounds moving ahead. Genomics actually has made an impact on drug discovery throughout the industry and has revealed new and exciting targets which are not “me too’s.” These may be new oncologics, antidiabetic meds, or kinder, gentler replacements for Geodon. However, it’s going to take a long time before these are realized, and a good number will drop out due to liabilities. That’s the nature of drug discovery and development. In the meantime, sales of Slentrol will feed back into R&D for these early stage programs. There are a lot of very smart scientists in drug discovery at Pfizer, and some are friends and former colleagues. As skeeved out as I am by Slentrol, its sales may help them continue with their research on innovations and may even help them retain their jobs.

Comments

  1. #1 JKB
    January 11, 2007

    …slack willies, and balding pates (re: Propecia) of the American populace are the market for the drugs decried as “medically unnecessary.

    Oh no, you did not just go there

    Fat dogs, and fat people are generally lifestyle decisions. Slack willies and balding pates are not. I note you failed to include pharma’s marketing of menopausal and post-menopausal drugs (HRTs) that appear to contribute to breast cancer. Creating more demand for treatment, were we? Appealing to a desperate consumer by pandering denial?

    I’ll contribute an obvious observation in pharmas money scooping trends. Payment by proxies for treatment is lucrative.

    1. If the patient can’t afford the drug because it’s priced ridiculously, spread the cost to others through insurance. Others pay medical bills; don’t worry — adding a few dollars to the cost of of a Ford is negligible. What could possibly be the consequence?

    2. If insurance won’t cover it, pass the buck to the government and blame the government’s overly generous social retirement system and boomer expectations for the diminishing pot.

    3. If dogs could pay for the treatment, I’m sure they’d be appalled by how sexually unattractive the extra pounds make them look and they’d pay. But since they can’t, appeal to the owner’s vanity and lack of responsibility. Shift the cost upwards where it can be hidden among other silly and discretionary expenses.

    Get the pattern? Charge others for treatments given to third parties by hiding and distributing costs among relatively disinterested parties.

    I’ve got my own idea on pooch fitness. Two words. Doggy Treadmills. Patent pending by the way. Manufactured in China of non-recyclable resources. Minimal eco-footprint.

    I’ll have diagrams later, but the design is deceptively simple, and as a byproduct will generate small amounts of energy sufficient to recharge the cellphone, laptop or iPod during brownouts. In no time those pooches will be as fit as working huskies on the Iditarod.

  2. #2 joan
    January 11, 2007

    I was reading about Slentrol the other day from an internet news site (scientific) link. I don’t remember which site to which I was directed, but http://news.yahoo.com/s/ap/20070106/ap_on_he_me/doggie_diet_drug lists vomiting, loose stools, diarrhea, lethargy and loss of appetite as possible side effects. I couldn’t find expected liklinesses of these effects happening (perhaps b/c drugs for animals have different testing/literature requirements?). I wonder if, even w/o the vomiting, the drug interracts w/ proper nutrient absorption. It’s doubtful, but hopefully pet owners will use it as a last resort treatment.

  3. #3 MattXIV
    January 11, 2007

    The market for this isn’t as frivilous as one may think. I’m guessing that the recommended usage of the drug would be in concert with decreased food intake and increased exercise isn’t a viable option for many older pets that have arthritis. If people are going to start putting down the green for diet drugs for their pets, they’ve probably already attempted the much cheaper methods of diet and exercise and had them fail to reduce the pet’s weight for whatever reason, so the choice at hand is probably between fat pet and medicated pet.

    The problem isn’t simply pharma not targeting drugs for diseases where most of the patients are impoverished is that even if the drugs were developed, they wouldn’t be bought. They wouldn’t even end up helping most of those who suffer from the diseases – what good is a shiny new antimalarial drug if nobody is going to buy it to give to the people who can’t afford it and if in a lot of cases the money would be better spent on better vector control and sanitation. Pharmacology is only one front these diseases can be fought on, and it isn’t necessarily the most efficient.

  4. #4 Doc Bushwell
    January 12, 2007

    All: Thanks for the thoughtful comments. The MT interface is befuckled as per usual so I can’t reply at length. Hopefully, I’ll be able to do so later.

  5. #5 Gingerbaker
    January 14, 2007

    The pharmaceutical industry is very good at creating markets for their products. They do this by starting a campaign to convince prescribers of the “need” for treatment of a particular condition. Depending on the drug’s potential, this campaign can last for years.

    I have seen this first hand. A certain IV antibiotic’s antibacterial spectrum was unusual in having activity vs B. fragilis, a natural and benign anaerobic inhabitant of the intestine. For years, the company vigorously persued a campaign of funding research to show the “need” to protect surgical patients from the ravages of B. frag infection, even though this was not a big issue. After about 3 years of the campaign, their IV antibiotic became the largest selling hospital-based antibiotic, supplanting generic combination products which worked just as well against the organism.

    The fact that MD’s and DVm’s are highly educated merely makes them more easily seduced by elegant red herring arguments.

    On the other hand, I asm not sure if the doggie diet pill fits into this category.

    The other aspect is that there is a possibility that this medication can actually do some good for the obese pets. What is so wrong with that?

    That health care dollars should not be spent on possibly “frivolous” treatments is, IMO, exactly what the insurance companies love to hear.

    The fact is, I strongly believe, there is plenty of money in this economy to provide all the healthcare anybody could desire – IF we spent our tax dollars constructively.

    The answer, I think, is to not spend our intellectual energies doing economic triage for the insurance industry, but rather to promote the idea that we can actually afford to make wonderful healthcare available to everybody if we change our government’s idiotic priorities and corruptable infrastructure.

  6. #6 Doc Bushwell
    January 18, 2007

    Gingerbaker:*

    The pharmaceutical industry is very good at creating markets for their products. They do this by starting a campaign to convince prescribers of the “need” for treatment of a particular condition. Depending on the drug’s potential, this campaign can last for years.

    Pretty much spot on, but I would change “creating markets” to “exploiting markets.” Using your B. fragilis example, the market was already present given that there were already effective combo generics in place for treatment. The IV antibiotic manufacturers exploited this and skewed the market.

    *”Toad” will be thumping around in my cranium today.

  7. #7 Doc Bushwell
    January 18, 2007

    JKB: My bad. I did neglect HRT marketing, but that’s due to egocentricity. I am foregoing pharmacological assistance through “The Change” and doing it the old fashioned way: screaming like a harridan and heating entire wings of buildings with my hot flashes. True, male pattern baldness is not a lifestyle choice, but are drugs treating it a major medical necessity. The same might be argued for the phosphodiesterase-5 (PDE5) inhibitors for ED although I can be convinced the drugs meet a need and likely many needs. I would imagine that swallowing a pill sure beats injecting one’s johnson with alprostadil. I would also expect erectile dysfunction is affected by the same conditions which are affected by obesity: diabetes and cardiovascular disease. To a certain extent, lifestyle would have an impact there.

    I think you could substitute “health care” for “pharma” with regard to money scooping. Hospitalization and hi-tech diagnostics are costly, too. It all gets spread through the third party system, but I kinda thought that was the point of insurance.

    You might take this with a grain of salt, given Malcolm Gladwell’s shtick of appealing simultaneously to liberal snobbery and capitalist greed, but check out his article, High prices: how to think about prescription drugs from the 2004 New Yorker.

    joan: Yes, it’s possible that Slentron could decrease nutrient intake in dogs. Although its exact mechanism for weight loss isn’t understood, it apparently interferes with fat absorption from the gut. Similarly, Xenical, a marketed drug for human weight loss, blocks far absorption. Patients taking Xenical are advised to supplement their diets with fat soluble vitamins A, D, and E. It’s plausible that something similar could happen to the dogs.

    Matt: Thanks for the thoughtful response. I completely agree with the point you make in your second paragraph, i.e., the money is better spent on better vector control and sanitation. In a similar vein, I would say that preventative medicine in the form of good nutrition and exercise is a first line approach for addressing those disorders exacerbated by excessive adipose.

    I’m not convinced about Slentrol as a last resort. I’d like to think that would be the case, but I expect many pet owners would go for it, or have it pushed on them, rather quickly. Of course, this remains to be seen as the adverse effects play out. Dogs are notorious for barfing up stuff which doesn’t agree with their GI tract.

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