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A Sticky Problem: Dealing with Industry Under Unpleasant Circumstances

Joseph S. Alpert

Joseph S. Alpert, MD


In this issue of the American Journal of Medicine, Dr Leonard Fromer appropriately calls for easier access to potential lifesaving therapy, the epinephrine auto injector, for patients with severe allergic reactions. The editor and the staff of the AJM strongly support the concept that epinephrine auto injectors should be made affordable and easily accessible for patients who are at risk for developing life threatening allergic reactions. I have personally known patients, friends, and family whose lives were likely saved by an injection of epinephrine from an auto injector. There is no doubt that this medical device should be readily available and reasonably priced so that anyone with need can obtain it. The review by Dr Fromer amply documents the evidence that the epinephrine auto injector is a lifesaving instrument for many individuals in the US and that it should be easily accessible. He further documents that access to this potentially lifesaving device is inadequate.


Unfortunately, if an epinephrine auto injector is very expensive, many individuals will be discouraged from purchasing the device, and undoubtedly there will be deaths as a result. I personally abhor the idea that a company that manufactures lifesaving pharmaceutical agents or devices, prices such items at a level that precludes many patients from buying it. In my opinion, such corporate behavior is immoral and anti-social and deserves strong condemnation. It is for this reason that I deplore the efforts of the current manufacturer of the epinephrine auto injector to increase both the cost and use of this device:

I am particularly incensed that material published in a legitimate and ethical biomedical publication, the AJM, may help this company to further their marketing strategy. This reminds me of the tales of the robber barons of industry who Teddy Roosevelt battled more than 100 years ago. Neither Dr Fromer nor myself were aware of the recent large increase in price of epinephrine auto injectors when his article was written and accepted by the AJM. We were surprised and disappointed when we were subsequently informed of the huge augmentation in price of this essential healthcare product. The AJM is now and will remain strongly opposed to what we consider to be excessive profiteering by companies who manufacture health related products.

One possible solution to such a problem is to encourage patients to order drugs or devices from Canada where pricing is considerably more favorable. I personally hope that the FDA and Congress will eventually concur with such a plan. Given the recent controversy over possible excessive pricing of epinephrine auto injectors by the manufacturer, we regret the fact that our review article might have assisted in what many believe to be excessive profiteering by the company manufacturing this device.1 The editor and the staff of the AJM were well aware that there had been industrial involvement in preparing this review. Typically, such involvement relates to corporate legal policies. Company reviews of written material involving their products are often requested by the company legal department in an attempt to avoid possible future litigation or FDA censure. It is regrettable that in the case of the epinephrine auto injector, Mylan did not inform Dr Fromer of the price increase during the writing of his article.

The editor in chief and staff of the AJM await further investigation into this controversy. We remain committed to the idea that epinephrine auto injectors should be made available to all who might need this product at a reasonable and rational cost. This is now the second time in recent weeks where we have had corporate involvement in an article that we published. I plan to be much more careful in the future when accepting manuscripts that involve healthcare products where one company is the sole manufacturer.


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-Joseph S. Alpert, MD (Editor in Chief, The American Journal of Medicine)

This article originally appeared in the December 2016 issue of The American Journal of Medicine.

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