Wyeth wins, horses lose, in the Premarin® drug sales sweepstakes

Written by JANE ALLIN
Research Analyst | Int’l Fund for Horses

Since the introduction of Premarin in 1942, much controversy has followed the lucrative market monopoly of the world’s first conjugated equine estrogen therapy for the treatment of postmenopausal women.

Historically, the number of PMU farms, sequestered mares and by-product foals steadily rose until the early 1990’s at which time a precipitous increase was observed (Figure 1). The escalation in the number of PMU farms appeared to coincide with the widespread compliance of physicians to prescribe Premarin® based on a powerful sales pitch by Wyeth that gave doctors and women alike the impression that every woman should be treated at menopause for declining estrogen levels and in particular the escalated risk of developing osteoporosis.

This marketing agenda not only falsely concluded that aging and menopause are diseases requiring treatment but also failed to admonish the inherent dangers associated with HRT. As far back as the mid-1970’s there was damaging evidence that the use of HRT was linked to cancer.

Figure 1. Historical trend of PMU farms, mares and foals – Manitoba Canada. Source: Government of Manitoba (1)

Apart from the burgeoning sales of Premarin® and then the inception of Prempro® in 1995, by the early 1990’s there was growing evidence about the risks associated with HRT. Meanwhile the Woman’s Health Initiative (WHI) was launched in 1991 with the objective of conducting medical research about health issues in menopausal women. These clinical randomized controlled trials were designed to test the effectiveness of postmenopausal HRT on heart disease, fractures and breast and colorectal cancer.

Until the time the first results of the WHI study were released in 2001, sales of the Premarin® family of drugs not only flourished but Wyeth gained a further foothold in the control of the marketplace when the FDA rejected an application for a generic brand of its blockbuster drug Premarin®. Both the FDA and Wyeth-Ayerst wanted the public to believe it was in their best interest to protect and safeguard but in reality it was motivated by scores of lobbyists, fraught with conflicts of interest, and epitomized by surreptitious political manipulation.

In fact, in the 1990s Premarin® became the most frequently dispensed drug in the US and by 1997 had become Wyeth-Ayerst’s first brand to reach $1 billion dollars in sales.

By 2001, news of the first results of the WHI hit both physicians and Wall Street alike and Wyeth-Ayerst’s epic family of HRT drugs nosedived in terms of company shares and market value. However, it wasn’t until the US government abruptly ended the WHI in 2002 citing the increased risk of cancers and cardiac complications that sales and use of the drugs by postmenopausal women plummeted.

As clearly illustrated in Figure 1, a steep decline in the number of PMU farms and producing mares was observed shortly after these events in response to the decreased demand of Premarin® and related CEE drugs. Although this may seem to have been a blessing to the suffering mares and their foals, sadly, the vast majority of the mares no longer required to “perform” were sent to slaughter along with their foals whether alive or still in the womb. Albeit lower numbers, the industry still thrives today and the suffering continues.

So where has that left Wyeth, now a subsidiary of Pzifer, the largest drug company in the world?

A closer look at the sales of Premarin® and projected sales of both Premarin® and their soon to be released Aprela conveys a malevolent tale of greed and depravity.

Data taken from a Wyeth Annual Product Sales summary clearly show the drop in profits from Premarin® from 2003 to 2004 that parallels the steep decline in the number of PMU mares as indicated in Figure 1. However, from 2004 and beyond sales increased slightly until 2006 and then remain relatively stable despite the fact that there were further declines in the number of PMU mares over the same period of time. Figure 2 shows the actual and estimated sales from 2003 to 2015 for both Premarin® and Aprela.

Figure 2. Actual and predicted sales of Premarin® and Aprela. Source: JP MORGAN US Major Pharma 2010 Outlook (2)

What is alarming is that the sales profits appear to be unaffected while at the same time both prescriptions for the Premarin® family of drugs and the number of PMU farms and mares have declined dramatically since 2003 (Figures 3 and 4 respectively).

Figure 3. Prescriptions of Wyeth’s HRT issued by physicians 2001-2008. Source: IMS Health The New York Times (3)

Figure 4. Total estimated PMU mares 2003-2007. Source: NAERIC, Government of Manitoba, Government of Alberta (4)

In fact, there was a decrease of approximately 80% in the number of prescriptions issued by physicians from 2001 to 2008 with a corresponding decrease of about 88% in the number of mares from 2003 to 2007 (estimated from current number of PMU farms and Manitoba/Alberta data). Somewhat confounding may be the prescription data since Premarin® is now available over the Internet without a prescription and so may not reflect the actual demand. However, more importantly, the number of producing mares divulges the underlying ambiguity.

A simple calculation of the profits generated per PMU mare from 2003 to 2007 will shock you (Figure 5).

Figure 5. USD sales generated per PMU mare 2003-2007. Source: JP MORGAN US Major Pharma 2010 Outlook, NAERIC, Gov. of Manitoba, Gov. of Alberta (5)

In 2003, it appears that a single PMU mare generated about 25,000 USD per annum in profits for Wyeth, yet by 2006 and 2007 that same mare was worth in excess of 150,000 USD –- that is a sixfold increase in a mere five years. It is hard to envision a mare ramping up urine and estrogen production to sustain these sales figures.

Instead it is simply a case of Economics 101; Supply and Demand. At least that’s what Wyeth wants the consumer to believe. Unfortunately there is a major flaw in their argument since the overall demand for the Premarin® family of drugs has in fact decreased over time due to the inherent risks of cancer and cardiovascular complications associated with HRT (Figure 3).

While, it is true that the supply of CEEs has decreased, presumably in response to decreased demand, Wyeth has had no other option than to increase the price of its carcinogenic therapies to sustain profit levels.

A CTV news release in June of 2009 documents the scandalous agenda of Big Pharma and its continuing predisposition to gouging the consumer. From April to June of 2009, a month’s supply of Premarin® increased an astonishing 800 per cent, from about 14 cents a pill to about $1.24 a pill. (6)

Unfortunately, when a patent expires there is no limit to what a company can charge for its drugs since its pricing doesn’t come under the jurisdiction of the federal government’s Patented Medicine Review Board (Canada).

Wyeth defends its position with the following gibberish:

The new price is reflective of current costs, including higher manufacturing and ingredient costs and a long-term, steady reduction in the consumption of the product, increasing the per-dose and per-patient cost significantly.”

“Wyeth Pharmaceuticals says its decision “was based on extensive research, including discussions with stakeholders, physicians and patients, and reflects the value Premarin brings to Canadian women. Key inputs from that research showed that Canadian physicians and women wanted us to continue to offer the product.

“While we understand this is undesirable for some patients, the only other option was to remove the product from the market, and many Canadian women continue to rely on this unique product.” (7)

Oh really? As if they would take it off the market. I hardly think so! After all, it is still accruing 1 billion USD a year and with the predicted arrival of Aprela in 2011, which also contains CEEs, Wyeth has estimated that figure to increase even further (Figure 2).

It is simply criminal what Big Pharma is allowed to get away with. Not only is it permissible to manufacture and deceptively market carcinogens, endangering the lives of women and horses alike, it is obviously clear that they can do so at any cost to the consumer. It is no secret that the FDA and the pharmaceutical companies are entwined in a sinister conspiracy, but what about the democratic governments of the United States and Canada?

The pharmaceutical industry is hardly a model of free enterprise. Of course, it is free to manufacture what drugs it sees fit to expand its portfolio of block-busters, many of which are merely slight modifications to existing compounds. It is also free to price them as high as the market will bear. Ultimately however, it is entirely reliant on monopolies delivered to them courtesy of the government, for example patents and FDA endorsed marketing rights.

There has never been a better time to stop this madness.

© Int’l Fund for Horses

LINKS TO SOURCES

(1) Government of Manitoba — http://www.gov.mb.ca/agriculture/statistics/yearbook2006/past_trends_other_farm_products.pdf

(2) JP MORGAN US Major Pharma 2010 Outlook — http://www.docstoc.com/docs/21388254/JP-MORGAN-US-Major-Pharma-2010-Outlook/

(3) IMS Health The New York Times — http://www.nytimes.com/2009/08/05/health/research/05ghost.html

(4) a. NAERIC, b. Government of Manitoba, c. Government of Alberta —
a. http://www.naeric.org/; b. http://www.gov.mb.ca/agriculture/statistics/yearbook2006/past_trends_other_farm_products.pdf; and c. http://www1.agric.gov.ab.ca/$department/deptdocs.nsf/all/sdd10294/$FILE/table67&68.pdf

(5) a. JP MORGAN US Major Pharma 2010 Outlook, b. NAERIC, c. Gov. of Manitoba, d. Gov. of Alberta —
a. http://www.naeric.org/; b. http://www.gov.mb.ca/agriculture/statistics/yearbook2006/past_trends_other_farm_products.pdf; c. http://www1.agric.gov.ab.ca/$department/deptdocs.nsf/all/sdd10294/$FILE/table67&68.pdf; d. http://www.docstoc.com/docs/21388254/JP-MORGAN-US-Major-Pharma-2010-Outlook/

(6) http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090603/premarin_090603/20090603/

(7) See above.

© Int’l Fund for Horses