Drug firm's movie gets mixed reviews

Source: http://www.twincities.com/allheadlines/ci_6033025?nclick_check=1

Depending on whom you ask, the movie "Innerstate" is either a touching documentary about people overcoming autoimmune diseases, or a sly tactic in "Big Pharma" advertising.

Either way, it's coming soon to a theater in Brooklyn Center.

"Innerstate" chronicles a race car driver with Crohn's disease, a countrywestern singer with rheumatoid arthritis and a restaurant manager with psoriasis. All three have comeback stories despite their incurable diseases.

"The movie was meant to inspire people and give people hope," said Janie Feliz, 20, the singer, whose condition hasn't slowed her drive toward a career in Nashville.

The controversy comes from the fine print. The hourlong movie is funded and produced by Centocor Inc., the maker of Remicade, the top-selling drug for autoimmune conditions, which result when the immune system mistakenly attacks healthy cells. All three people in the movie take Remicade, and while the brand name isn't mentioned in the film, some critics believe it is an advertisement masquerading as a documentary.

"Innerstate" reflects a blending of advertising and art taking place in much of American culture. The movie's indirect approach also reflects a softer edge from a drug industry that usually hammers home brand names and catchphrases such as the Purple Pill. The idea of such "patient education" or "disease awareness" is to inform people about diseases so they are motivated to learn about treatments on their own.

"It's a means to create marketing buzz about these diseases," said Jon Schommer, a drug-marketing expert with the University of Minnesota College of Pharmacy.

"Innerstate" has appeared in 10 cities since February, and concern has been building. A labor union in Philadelphia complained last week that, although the drug name isn't mentioned in the movie, it is featured prominently in materials distributed after the show. The union represents custodians who clean Centocor's offices.

Centocor created the movie to inform the public about diseases that are poorly understood and can cause pain and humiliation for patients, said Michael Parks, Centocor's vice president of communications.

Remicade is a biologic drug, meaning it is made from human cell cultures, and it disrupts how the immune system attacks the body. There are several competing drugs for autoimmune diseases, but Remicade is the market leader, producing $3 billion in sales last year for Centocor and its parent company, Johnson Johnson.

Doctors have reported remarkable turnarounds for patients with autoimmune diseases since these drugs were developed. Previously, there was little to stop rheumatoid arthritis, for example, which deforms joints and causes severe pain and swelling.

Crohn's inflames the digestive tract, raising the risk of colon cancer and causing pain and chronic diarrhea. Psoriasis causes flaky, scaly skin that is not only uncomfortable but also can embarrass sufferers.

"Innerstate" opens with Jason Knott, 33, who grew up with psoriasis and skin lesions covering as much as 80 percent of his body. He recalls in the film how parents pulled their children out of the water as he dipped into a neighborhood pool.

Centocor's Parks selected the three patients for the film, focusing on young, active patients to break down myths about the diseases.

"It is, in our mind, unconscionable that psoriasis patients are still treated like lepers," Parks said. "It's not a communicable disease."

Public stigma over autoimmune diseases came up during this session of the Minnesota Legislature, when lawmakers took ridicule for voting to guarantee that people with Crohn's disease or ulcerative colitis could use restrooms in private buildings or retail stores.

Ray Ciccarelli, who is profiled in the movie, has Crohn's disease. The 36-year-old now races in a NASCAR junior league, but prior to treatment, he rarely left his house for fear of not getting to a bathroom in time.

Regardless of whether "Innerstate" is intended as marketing, analysts believe it will help Centocor. As the market leader, it benefits from anything promoting the diseases its drugs can treat.

The key question is whether the film crosses the line from information to persuasion, said Schommer, the U expert, who has not seen the film.

Centocor appears to be using a marketing strategy common in Europe, where drug companies are banned from advertising directly to consumers, Schommer said. The strategy is to heighten public awareness about a disease and then arm physicians with drug information and samples they can offer when patients come to them with questions.

"The successful ones have it orchestrated beautifully," Schommer said.

Dr. Carolyn Bowles believes it is marketing, and that drug companies are poor sources for patient education. The Edina rheumatologist nonetheless accepted Centocor's invitation to speak after the June 9 screening in Brooklyn Center.

She said some patients don't need Remicade, which has such powerful effects on the immune system that it can increase the risks of infections such as tuberculosis.

Others need it earlier but are forced to wait because of insurance restrictions, she said. Remicade is given by infusion and costs each patient $12,000 to $20,000 per year.