And speaking of vapid coverage, an accompanying article in the NEJM that claims the higher use of Vytorin in the US was due to DTC provides no evidence of cause and effect or association. Rather, it does put it's finger on the real reason: Canada health system delayed and restricted access:
"Vytorin has been available in the United States since July 2004 but is still not available on the Canadian market. The use of ezetimibe-containing products in the United States increased sharply with the introduction of Vytorin. Some U.S. clinicians may have adopted the combination cholesterol-lowering product to improve adherence to dual therapy, but this option was not available in Canada. Third, in Canada, publicly funded provincial drug formularies have been conservative in their coverage of ezetimibe. Two of the three provincial government-funded formularies that serve three provinces (Ontario, Quebec, and British Columbia), in which approximately 75% of Canada's population lives, list ezetimibe with prescribing criteria that limit its use to patients in whom the target level of LDL cholesterol has not been achieved with a statin and patients who cannot tolerate or have a contraindication to statins; a third formulary does not even list ezetimibe as a benefit, although it is currently under review. These formulary criteria appear to be consistent with guideline recommendations that favor medication classes for which data on outcomes are available. Public formulary listings often influence medication coverage in private Canadian drug plans.
Oh.
But watch how many media articles cite DTC as the culprit. This is typical of the the quality of the case against DTC.
http://content.nejm.org/cgi/content/full/NEJMsa0801461
"Vytorin has been available in the United States since July 2004 but is still not available on the Canadian market. The use of ezetimibe-containing products in the United States increased sharply with the introduction of Vytorin. Some U.S. clinicians may have adopted the combination cholesterol-lowering product to improve adherence to dual therapy, but this option was not available in Canada. Third, in Canada, publicly funded provincial drug formularies have been conservative in their coverage of ezetimibe. Two of the three provincial government-funded formularies that serve three provinces (Ontario, Quebec, and British Columbia), in which approximately 75% of Canada's population lives, list ezetimibe with prescribing criteria that limit its use to patients in whom the target level of LDL cholesterol has not been achieved with a statin and patients who cannot tolerate or have a contraindication to statins; a third formulary does not even list ezetimibe as a benefit, although it is currently under review. These formulary criteria appear to be consistent with guideline recommendations that favor medication classes for which data on outcomes are available. Public formulary listings often influence medication coverage in private Canadian drug plans.
Oh.
But watch how many media articles cite DTC as the culprit. This is typical of the the quality of the case against DTC.
http://content.nejm.org/cgi/content/full/NEJMsa0801461
