NPR had an excellent presentation on how Merck increased the sales of its Fosamax pill which increased bone density and reduced bone fractures from osteoporosis. Bone density diagnosis machines were expensive and there were thus few of them. It worked with and eventually threated the manufacturerers into reducing the cost so that most Doctor's offices had one. The result was that many women were diagnosed with osteopenia, a milder form of loss of bone. However, although fosamax increased bone edesnisty, one study showed that it did not decrease the risk of fracture, and, in fact, there are anecdotal reports that it might even make the bones more brittle increasing fracture risk. A Rome medical meeting looked at different bone density numbers and arbitarily divsiions between the numbers where a women would be diagnosed with osteoporosis, osteopenia and normal bone density. (My mother and myself also found fosamax could cause problems with dental disorders.)
A pharmacoepidemiologist said that often drug manufacturers would take a drug effective in severe cases of a disease, and market it for those with midler forms. It was not clear that the drug was helpful in these situations and whether the risk of side effects, etc. outweighted any benefit it might provide for those with milder forms.
The problem is that we need to reward drug manufacturers for beneficial results for patients after a long term, and not reward drug companies every time a doctor prescribes the drug, that is for sales.
I spoke about this a little in the fouth part of my four-part participatory plan for health care reform.