- The Washington Times - Thursday, June 6, 2002

NEW YORK The debate over aggressive marketing of prescription drugs and other pharmaceutical products is about to get a new twist.
Myriad Genetics Inc., which makes tests for genetic predisposition to certain kinds of cancers, is starting a big marketing push with doctors this summer. In the fall, it will start a direct advertising campaign targeting women and promoting tests for breast and ovarian cancers.
As in other ads for prescribed products, viewers are urged to consult their doctors. But these ads apparently are the first of their kind to promote genetic testing directly to the public and a part of a controversial marketing effort to expand distribution of Myriad's products.
The Salt Lake City-based company has developed tests that assess a person's risk of developing genetic forms of breast, ovarian, colon, uterine and skin cancers, and can also help determine which hypertension drugs are best for a patient.
Until now, they have been marketed only to doctors through an 85-person sales force. This summer, under a market agreement signed in December, the 600 sales agents of Laboratory Corp. of America Holdings will also begin marketing the drug tests to 200,000 doctors.
Dr. Gregory Critchfield, president of Myriad Genetic Laboratories Inc., the test subsidiary, said the campaign is designed "to make these tests for mainstream."
He said doctors must be more familiar with the tests and more attuned to patients' family histories to detect which groups are at risk for genetically based cancer. In the fall, a television, print and radio campaign focusing on tests for breast and ovarian cancer will be test marketed in Atlanta and Denver.
"We think the public needs to know, too," he said. "We think the information needs to come in both directions."
Some doctors and health advocates contend that, with a relatively small real market for the tests and with many doctors already aware of them, the campaign is too much of a simple push for profits.
They fear that it could cause unnecessary anxiety, increase medical costs and even create a false sense of security, with a negative result being misinterpreted as a clean bill of health for all kinds of cancer.
Doctors estimate that 5 percent to 10 percent of cancers are genetically based. The tests cost $745 to $2,760.
"I'm worried about marketing overstating the benefits of these tests and that, despite everyone's best intentions, they won't be used properly," said Dr. Richard Roberts, chairman of the American Academy of Family Physicians.
"Mark Twain once said that someone with a new hammer thinks of the world as a nail," he said. "I know where to find these tests, and I've never felt deprived because someone wasn't marketing them to me."
Most agree these tests are appropriate for a small subset of patients who have a family history of cancer that suggests a genetic origin.
Breast cancer diagnosed in women who have not reached menopause is typically genetically based. Colon cancer in individuals younger than 50 is also genetically linked. Only patients with close relatives with such histories should receive the test, experts say.
Dr. Critchfield says sales representatives are trained to explain to doctors that only a small group of patients should take the tests and to leave brochures outlining the criteria with physicians. No patient is given the test if counseling hasn't been provided, he said, and follow-up counseling is also required.
Couselors help patients deal with the emotions the test may raise, such as fears after a positive result or even guilt from a negative outcome when other family members have been stricken with cancer. Medical options are outlined for those who have tested positive.
"This isn't something we take lightly," Dr. Critchfield said.
He says Myriad will train doctors to guide patients through the process. Others insist counseling should only come from genetic specialists.
"Genetic specialists go to school for years. It is not something you can train someone to do in an hour," said Barbara Brenner, executive director of Breast Cancer Action.
Miss Brenner opposes direct marketing of the breast cancer test. "It is not about saving women's lives. It is about increasing market share," she said.
In a breast cancer test, a woman who tests positive for a mutation of either of two genes, has an 87 percent chance of developing the cancer. But there is no way to know if she will beat the odds.
Those who have the mutation can choose preventive mastectomy or chemotherapy. Most choose vigilant surveillance through self-exams and mammograms instead.

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