Two weeks after the New England Journal of Medicine published a study finding that aggressive treatment of anemia in kidney disease patients results in more heart problems and deaths, the National Kidney Foundation (NKF) is planning to assess the overuse of anemia treatment drugs. Alex Berenson reports for the New York Times that the NKF “plans to assess whether hundreds of thousands of patients with kidney disease are being dangerously overtreated with drugs for anemia.” The NKF assessment should be publicly available by March 2007.
Unfortunately, all indications are that NKF’s involvement will be based solely around financial criteria. Not so much as a mention of patient outcomes or quality of life issues, but NKF representatives are quick to acknowledge the financial repercussions of any outcome: “There are substantial sums of money involved here” was all Kerry Willis, vice president for medical and scientific activities of the National Kidney Foundation, had to say to Berenson.
According to Berenson’s report, sales of the Epogen, Procrit, and Aranesp anemia treatment drugs will reach almost US$10 billion in worldwide sales this year, with Medicare alone spending US$2 billion on the drugs for dialysis patients. 500,000 kidney patients receive the drugs.
Again, with no mention of patient outcomes, Berenson focuses on the financial angle (which is fully warranted, but not the whole story):
“But some independent scientists say they believe that kidney patients are receiving too much of the drugs, in part because dialysis clinics make bigger profits for providing higher doses. The clinics make little profit on the actual dialysis services they provide for Medicare enrollees, who are the vast majority of dialysis patients.”
Berenson cites scientists who complain that Amgen, one of the two companies—Johnson & Johnson is the other—that make the anemia treatment drugs, “has until now had too much influence on the creation of the foundation’s guidelines. The most recent version of the anemia guidelines, released earlier this year, encourages more aggressive treatment than the Food and Drug Administration recommends.”
“‘The guidelines are funded through the National Kidney Foundation by industry, by and large,’ said Dr. Daniel Coyne, professor of medicine at Washington University in St. Louis. ‘They write guidelines that are opinion-based, by and large, and favor industry or would appear to favor industry.’”
Amgen, for example, donated US$4 million to NKF in 2005.
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