Comment les labos se cachent derrière des campagnes de sensibilisation apparemment « neutres »



L’industrie pharmaceutique contourne la loi en finançant des campagnes de « prévention » qui sont en réalité des opérations marketing déguisées. Exemple avec la campagne de sensibilisation sur le psoriasis et le médicament qui coûte le plus cher à la Sécu, l’Humira, du laboratoire Abbvie.

« Noémie, 19 ans, n’en peut plus. Et pourtant il existe des solutions. » Fin novembre, ces posters ont envahi le métro parisien. Selon l’association France Psoriasis, qui a lancé la campagne, celle-ci coûte « dans les 10 000, 20 000 euros la semaine d’affichage ». Comment l’association de patients l’a-t-elle financée ? Grâce à l’aide du ministère de la Santé ? Aucunement. Ce sont des laboratoires pharmaceutiques, et notamment Abbvie et Celgene, qui en sont les généreux sponsors (lire notre brève sur le sujet). Le laboratoire Celgene n’en est pas à son coup d’essai : il a déjà financé une campagne sur le même sujet l’an dernier, encore plus massive : elle aurait coûté entre 40 000 et 50 000 euros.

Campagne France Psoriasis 2018.




Campagne Psoriasis 2017 (Celgene).

Selon l’association France Psoriasis, 1,5 million de Français au moins seraient touchés par un psoriasis, soit plus de 2 % de la population. À première vue, ses effets semblent relever de la dermatologie pure. En réalité, il s’agit d’une maladie chronique inflammatoire de la peau, mais aussi des articulations. Elle provoque des plaques rouges et des démangeaisons, ainsi que des rhumatismes dans un cas sur trois. D’où la collaboration entre France Psoriasis et les associations de rhumatologues ou liées aux patients qui souffrent de rhumatismes (Aflar, AFS, Andar, SNMR et CFMR) pour cette campagne grand public.

Le psoriasis, nouveau marché des labos

Pourquoi les laboratoires visent particulièrement les personnes souffrant de psoriasis ? 500 000 nouveaux malades potentiels de rhumatismes psoriasiques, parmi l’ensemble des personnes souffrant de psoriasis (1), c’est énorme pour le marché des pathologies peu communes. Chaque nouveau patient représente une précieuse source de profits pour les laboratoires qui produisent les traitements donnés aux personnes souffrant de maladies chroniques inflammatoires invalidantes comme la polyarthrite rhumatoïde, la spondyarthrite ankylosante, le rhumatisme psoriasique, mais aussi la maladie de Crohn. D’autant que l’industrie a mis sur pied des traitements de choc, les anti-TNF (Tumor Necrosis Factor). Ces derniers sont normalement prescrits pour les cas les plus graves, quand les autres remèdes ne suffisent pas à diminuer l’inflammation et donc les symptômes des rhumatismes inflammatoires (douleur, raideur, gonflement…).

« Pour nous, souffrant de psoriasis, les industries pharmaceutiques représentent un espoir. Pour elles, nous représentons un marché. »




Le best-seller de ces médicaments contre les rhumatismes psoriasiques ? L’Humira, un anti-TNF, produit par Abbvie. Le laboratoire étasunien est d’ailleurs l’un des financeurs de la campagne France Psoriasis, aux côtés d’ « une quinzaine d’entreprises pharmaceutiques »« Le soutien financier multi-laboratoires garantit notre indépendance », assure Roberte Aubert, la présidente de l’association. « C’est nous qui leur soumettons notre campagne en leur demandant de nous aider. Le fait que nous incitions les gens à se soigner intéresse les industries pharmaceutiques, admet Roberte Aubert, elle-même atteinte de psoriasis. Pour nous, elles représentent un espoir. Pour elles, nous représentons un marché. »

Un remède, l’Humira, médicament qui coûte le plus cher à la Sécu



Et quel marché ! Coût d’une injection de l’Humira : entre 187 et 677 euros. Avec l’arrivée à expiration du brevet de l’Humira et le débarquement de ses équivalents génériques (appelés biosimilaires) sur le marché cette année, les prix ont légèrement diminué (de 7 %) : une boîte de deux injections étaient vendues 814,58 euros en mars et vaut 756,37 euros depuis avril. Ce qui revient à un coût de 9 076 euros par an pour une patiente sous Humira atteinte de la maladie de Crohn qui nous a présenté ses factures. Le tout est entièrement remboursé par la sécu puisque le médicament soigne une affectation de longue durée. D’après notre classement des médicaments qui coûtent le plus cher à la sécurité sociale (lire notre article), l’Humira conserve sa première place de remède le plus onéreux (487 millions d’euros en 2017). Depuis 2005, l’assurance maladie a dépensé pas moins de 3,387 milliards d’euros pour ce traitement.

Inciter médecins et patients à passer aux traitements plus onéreux

« Sept patients atteints de rhumatismes sur dix ne sont pas traités par anti-TNF », rappelle Laurent Grange, rhumatologue au CHU de Grenoble et président de l’Association française de lutte antirhumatismale (Aflar) qui regroupe patients et médecins. Pour la majorité, les anti-inflammatoires non stéroïdiens peuvent suffire. Le coût de ces médicaments sont bien moins élevés que les anti-TNF : de l’ordre d’une centaine d’euros par an, seulement. Les laboratoires ont clairement intérêt à inciter médecins et patients à passer aux anti-TNF. François Pesty, pharmacien, expert conseil indépendant et membre du Formindep (2), met en avant une étude qui montre que pour la polyarthrite rhumatoïde, dont le traitement coûte encore plus cher que celui pour la maladie de Crohn, « une vraie alternative existe, aussi efficace, mieux tolérée et beaucoup moins onéreuse que les anti-TNF associés au méthotrexate » (3).

« Le risque, c’est bien sûr que l’entreprise pharmaceutique en profite pour réaliser de l’information promotionnelle. »




Malgré ces alternatives, les laboratoires tentent de mettre en avant des produits plus onéreux. Aux États-Unis, le laboratoire producteur de l’anti-TNF star, Abbvie, a dépensé 32,3 millions de dollars pour l’Humira dans une campagne de publicité télé en 2016. En France, les laboratoires ne peuvent légalement pas faire la promotion d’un médicament remboursé par l’assurance maladie auprès du grand public : d’où l’intérêt de le faire indirectement par les associations de patients. « Le risque, c’est bien sûr que l’entreprise pharmaceutique en profite pour réaliser de l’information promotionnelle », commente Magali Leo. La responsable du plaidoyer de l’association Renaloo, qui regroupe des patients malades des reins, est coauteure de la mission « information et médicament », qui a rendu des conclusions à charge sur la gestion de la crise sanitaire du Levothyrox.

Abbvie, sponsor et donateur d’associations de patients

Abbvie est le deuxième laboratoire qui finance le plus France Psoriasis (138 000 euros en six ans), selon l’outil EurosForDocs, qui recense les données de la base Transparence Santé. Idem pour l’Aflar, soutenue par Abbvie à hauteur de 92 920 euros depuis 2012 (l’ensemble de l’industrie pharmaceutique lui a versé 435 689 euros) . « S’il y avait un financement public des associations de patients, cela réglerait les problèmes de liens d’intérêts : ce n’est pas le cas, indique Laurent Grange, président de l’Aflar. Soit on ne fait rien, soit on fait avec les laboratoires car ce sont eux qui ont de l’argent, mais on le fait avec éthique, en validant scientifiquement les campagnes, et avec les patients. » Une posture qui suscite la critique : « Quand une association de patients est financée par un laboratoire, elle n’a pas intérêt à demander une baisse du prix du médicament », dénonce quant à elle Elise Van Beneden, avocate de l’association de lutte contre la corruption Anticor (4) (lire notre article « Les associations de patients, des alliés précieux pour l’industrie du médicament et des implants médicaux »).

Données EurosForDocs.

Pour Roberte Aubert, présidente de France Psoriasis, le but de la campagne est que malades et médecins « pensent à réaliser un test de dépistage ». Test créé et financé par… Abbvie, derrière une autre campagne du même acabit, « Ne lui tournez pas le dos ». Or le Formindep en conteste la fiabilité, dans une analyse publiée sur son site : « Ce test est uniquement destiné aux personnes dont la douleur du dos persiste depuis plus de trois mois. Pour les autres, le test n’a aucune valeur. (…) Pourquoi n’avoir pas ajouté une première question qui mettrait fin au questionnaire en cas de réponse négative : “Votre mal de dos persiste-t-il depuis plus de 3 mois ?” Ce qui aurait permis d’informer clairement et de limiter le mauvais usage du test. L’objectif réel est-il de maximiser le nombre de répondants ? », s’interroge le Formindep. « Cinq questions générales incitent à “consulter sans attendre” pour 42 répondants sur 100. Si le test vous annonce la possibilité d’une maladie inflammatoire, votre risque d’avoir une spondyloarthrite axiale est en réalité de 7 %, votre risque d’avoir une spondylarthrite ankylosante de 2 %. 93 % de ces personnes sont alarmées à tort », conclut l’association pour une formation médicale indépendante.

Entretenir la confusion entre un simple mal de dos et des maladies rares

Campagne « J’ai trop dansé » (Abbvie, 2018).




Sous couvert de « sensibilisation », cette campagne marketing entretient la confusion entre un simple mal de dos, banal puisqu’il touche 80 % des Français à un moment ou à un autre de leur vie selon l’OMS, et des maladies rares comme la polyarthrite rhumatoïde, qui concerne entre 0,3 et 1 % de la population, ou la spondylarthrite ankylosante dont souffrent 300 000 Français… Le slogan de la campagne de 2018  :« J’ai trop dansé #j’aimalaudos Et vous ? », du nom de la chanson de Mokobé, parrain de l’opération: « allo docteur, j’ai trop dansé, sur la piste j’ai trop dabé, je suis fatigué… » Or les maladies rhumatismales exigent au contraire de l’exercice pour ne pas empirer : la campagne frôle la désinformation. Le service communication d’Abbvie justifie ainsi son investissement : « En tant qu’acteur de santé, nous considérons que nous avons une pleine légitimité à participer à des campagnes d’information sur les pathologies dans lesquelles nous sommes investis, dans un objectif d’amélioration de la prise en charge des malades. »

Profil de Philippe Goupille sur EurosForDocs.

Le but mis en avant est d’« éviter le sous-diagnostic »« Pour le cas de la spondyloarthrite, on a longtemps dit que le délai moyen entre le début des symptômes et le diagnostic était de 6 ou 7 ans. Il s’est peut-être réduit grâce à des campagnes de prévention, comme celle menée par “Ne lui tournez pas le dos” », estime d’ailleurs Philippe Goupille, rhumatologue au CHRU de Tours dans un entretien publié sur le site même de la campagne… Le médecin a entretenu 702 liens d’intérêts avec l’industrie pharmaceutique depuis 2012. Celle-ci lui a octroyé au moins 186 875 euros (163 montants de contrats ne sont pas déclarés), soit 31 146 euros par an et 2 595 euros par mois, selon EurosForDocs. Essentiellement MSD, qui l’a financé à hauteur de 39 642 euros (6 607 euros par an) et Abbvie, pour 34 746 euros, soit 5 791 euros par an.

MSD et Abbvie ? Deux des trois laboratoires qui produisent les coûteux anti-TNF : le Remicade pour MSD et l’Humira pour Abbvie (le troisième étant l’Enbrel de Pfizer). Philippe Goupille n’a pas souhaité répondre à nos questions.

Des risques de surdiagnostics et de prescriptions dangereuses

Il y a des chances que ces campagnes alarment même les moins hypocondriaques des patients, qui se précipitent chez les rhumatologues. Qui eux-mêmes ont été sensibilisés au dépistage de ces maladies rares par les laboratoires… Les rhumatologues représentent d’ailleurs la 13e spécialité la plus approchée des labos selon EurosForDocs (lire notre article « Les labos soignent plus particulièrement les spécialistes du cancer »). Ainsi, ils ont davantage en tête ce diagnostic, qui dicte leurs ordonnances. D’où le risque inverse de surdiagnostics et de surprescriptions d’anti-TNF.

Des médicaments qui peuvent provoquer l’aggravation ou l’apparition d’un psoriasis.




Or ces traitements sont loin d’être anodins. Ce sont des immunosuppresseurs : ils diminuent les réactions immunitaires, donc les défenses des malades face aux infections. Une étude brésilienne montre que l’espérance de vie des personnes atteintes de polyartrite rhumatoïde a diminué à partir de 2002, après l’apparition des traitements anti-TNF. La fameuse balance bénéfices-risques se discute. En cas de prescriptions à mauvais escient, il ne reste que les risques. Le site de France Psoriasis cite en toutes lettres les noms des anti-TNF et mentionne deux effets secondaires liés à ce traitement : l’apparition de cas de tuberculoses et de cancers cutanés. Auxquels s’ajoutent en réalité le risque de subir davantage d’infections et les nombreux effets indésirables mentionnés dans la présentation Vidal du médicament. Dont « l’aggravation ou l’apparition d’un psoriasis ».
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