Drug companies don't give a damn

Drug companies are there to make money, not to look after patients. NovoNordisk produces Mixtard 30, a type of insulin which many diabetics take, but which no longer makes very much money for NovoNordisk. They are therefore withdrawing the product, so as to force diabetics in the UK to change to one of their newer products that cost more money. Good business sense. Bad for patients. What's the answer?

Editorial at British Medical Journal reproduced below

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Withdrawal of Mixtard 30: who on earth cares?
Ike Iheanacho, editor, Drug and Therapeutics Bulletin
iiheanacho@bmjgroup.com

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In the end, numbers alone aren’t enough. That one in every 300 of the world’s people have had their lives or wellbeing ruined by a stunning natural catastrophe seems to have provoked little more than a shrug of indifference from the other 299. The underwhelming global reaction to the flooding in Pakistan should be food for sobering thought for those wishing to bring health and social problems to the attention of an otherwise uncommitted audience.

If minds aren’t engaged by the plight of 20 million, what hope is there for a mere 90 000 facing a real but comparatively minor trial (albeit closer to home)? This is the estimated number of people with diabetes in the United Kingdom who currently use Mixtard 30, a biphasic human insulin sold by Novo Nordisk. Not for much longer, though, as the company intends to withdraw the drug from the UK market at the end of this year (BMJ 2010;341:c4210, doi:10.1136/bmj.c4210).

It would be easy to focus on the commercial reasons for this decision, in particular, the company’s desire to promote the use of newer, insulin analogue products rather than older drugs such as Mixtard 30. But in some ways, that’s the most predictable and least interesting bit of the story. What’s more surprising is the muted public reaction to the impending change—the prompt for Drug and Therapeutics Bulletin’s recently launched campaign (2010;48:85, doi:10.1136/dtb.2010.08.0040) and online petition against withdrawal of the drug (www.thepetitionsite.com/1/withdrawal-of-mixtard-30-from-the-uk-market).

On the face of it the situation has enough ingredients to disturb anyone who supports best practice in health care. Firstly there’s the anxiety and disruption that the enforced termination of established treatment will cause for people with diabetes and their families. And it’s not as if they can be reassured that the change is clinically necessary or advantageous, given the lack of evidence that the alternative biphasic analogue insulins are any safer or more effective than Mixtard 30. Also, these alternatives tend to be more expensive. And that’s not the only source of added pressure for the NHS: somehow resources will have to be found for the individual patient reviews and follow-up needed to ensure that tens of thousands of patients are switched to and settle on substitute insulin treatment.

But in the end you could be forgiven for concluding that none of this matters much, such is the lack of obvious protest from some of the patients’ groups and professional bodies with an interest in diabetes. Maybe the fact that these dogs haven’t barked much is the most intriguing feature of all.

Cite this as: BMJ 2010;341:c4634