OK, so while the actual title of the piece over at NPR is How A Bone Disease Grew To Fit The Prescription, they could have easily used my title.
Here are some choice excerpts.
On defining what is Osteoporosis:
“Ultimately it was just a matter of, ‘Well … it has to be drawn somewhere,’ ” Tosteson says. “And as I recall, it was very hot in the meeting room, and people were in shirt sleeves and, you know, it was time to kind of move on, if you will. And, I can’t quite frankly remember who it was who stood up and drew the picture and said, ‘Well, let’s just do this.’ ”
On creating the definition of Osteopenia:
To address this issue, Tosteson says, the experts — more or less off the cuff — decided to use the term osteopenia. Tosteson says they created the category mostly because they thought it might be useful for public health researchers who like clear categories for their studies. They never imagined, she says, that people would come to think of osteopenia as a disease in itself to be treated. The chairman of the meeting, John Kanis, of the WHO Collaborating Centre for Metabolic Bone Diseases, says the same thing.
On the introduction of Fosamax:
“Fosamax was the first [nonhormonal] drug that could credibly make a claim to stop the progress of osteoporosis,” he says.
drugs like Fosamax began to emerge, the standard treatments were
calcium, vitamin D, weight-bearing exercise and hormonal treatments,
though ultimately hormonal treatments proved problematic.
The problem that Merck was having is that Fosamax wasn’t selling. So they created the ‘Bone Measurement Institute,’ that was made up by a single person. The institute (and Merck) began to push small cheap machines to measure bone density:
The problem with the smaller peripheral machines, according to Mazess, is that taking a measurement of someone’s heel or forearm isn’t going to tell you what you need to know about the bones in the parts of the body that, if fractured, increase a woman’s risk of death — the hip and spine.
“We were not about to go ahead and tell physicians to use inadequate diagnostic equipment simply because Merck wanted that,” Mazess says. And Mazess says because Lunar refused to cooperate, his company was threatened. He says Merck told him, ” ‘You’re not going to get support from Merck. And we will support your competitors, and we will tell people working with Merck not to use Lunar machines.’ “
Merck worked to get these bone scans reimbursed by Medicare. They also worked hard to get these machines into as many doctor offices as possible. Merck got a low dose version of Fosamax approved in 1997 in order to “treat” osteopenia:
“I think the critical event in turning osteopenia into a condition that people believe needs treatment is the report that comes from the bone density machines,” Cummings says.
Most of the machines that ended up in doctors’ offices in the wake of the 1997 legislation would scan the bone and then spit out a report with three distinct colors: green, yellow and red. Green meant normal. Red meant osteoporosis. Yellow meant osteopenia.
The very existence of the word “osteopenia” on a medical report, along with the clear green-yellow-red graph, had a profound effect, says Cummings.
According to the article, the problem with giving Fosamax to those with osteopenia is that it doesn’t give a significant reduction of bone fractures that women with osteopenia are likely to get. There are no long term studies that link Fosamax with a reduction of fractures and can needlessly expose women to serious side effects. Finally:
“There’s a powerful economic incentive for pharmaceutical firms to expand the boundaries of the use of different therapies. So whether you consider treatments for osteoporosis or treatments for depression or treatments for high cholesterol — in all of these settings — pharmaceutical firms stand to benefit if the therapies for these diseases are broadly used,” Alexander says. “Even if they’re used among people who have very mild forms of these diseases.”
If you have osteoporosis or are concerned with developing it, I recommend weight bearing exercises and Vitamin D (remember 75% of us are low in it). I’ll also look at minerals (besides calcium, boron and strontium will show).
Osteopenia: How Merck Manufactured An Epidemic To Sell Fosamax