|
I present the following to you as an example that
you should check and study everything before attempting to jump on
any bandwagon. In healing or undertaking the reversal of any disease
be aware that not only are the Medical establishment at fault but
also the alternative. It would be ridiculous for us to believe that
there are others in this society that think of your health more than
they think of their living standard. We all have bills and
commitments, we all need to live and that takes money, some just
think that at least they are not hurting others, while some really
don't care as long as they sell their product. Think about all the
crazes that we endured during the years, you know the ones I mean.
We all jumped on the bandwagon when they came out, the manufacturer
of these vitamins, nutritionals or therapies became rich and went to
the next one. there are endless stories of these mass marketers that
create multi-level organizations and then close them only to open
another in a short time. I have been involved with many personally
and I never made any money, I do know that the owners did however
and when they had their fill would go on to the next hype and just
make some more. I do not agree with either but more encourage all
those to take their own health in to their hands and do it yourself,
it is a lot easier than having to trust or rely on others, only you
know what is wrong, only you know what you feel, do not allow
yourself to be put in a category, we are all different, we are all
intelligent enough to do this for ourselves, our families and our
children....
ALTERNATIVES Knowledge is power. So also is supposed knowledge. Which is why
those who practise mysterious skills have also been extremely
anxious to conceal exactly what it is they do. If the ancient Greeks
had been able to see the backstage activities of the priests of the
Oracle at Delphi, those priests would soon have been out of a job.
Nobody appreciates this better than the alternative therapist. The placebo effect Conventional vs Alternative Medicine The superior doctor prevents sicknessConventional medicine is not without its faults. It relies not so much on preventing disease, but on treating it. To this extent, if the Chinese proverb is to be believed, conventional medicine is practised largely by mediochre and inferior doctors. They also concentrate on treating specific disorders or symptoms rather than the whole person. Alternative medical practitioners, on the other hand profess to take a different approach, treating the person as a whole – a 'holistic' approach – rather than symptoms, although not all do: homoeopathy, for example, concentrates on creating the same symptoms as the disease being treated.
Alternative medicines In considering or selecting a medical treatment within conventional medicine, there is always recourse to their governing body or to law if anything goes wrong; outside conventional medicine, this may not be the case. It seems to me sensible to look at both before deciding on which way to go. Below are some of the more popular alternative treatments that appear to me to have an unscientific foundation.
Acupuncture
Aromatherapy Bach's Flower Remedies see Homoeopathy. Biomagnetics, Radionics, and Radiesthesia Chiropractic see Osteopathy. Colour Therapy
Dianetics Eye Exercises Faith Healing Homoeopathy and Bach's Flower Remedies. Iridology Metamorphic Technique see Reflexology Naturopathy New Age Treatments Osteopathy, Chiropractic and Somatography Radionics see Biomagnetics Reflexology or Zone Therapy, and Metamorphic Technique
Spondylotherapy Trepanation Zone Therapy See Reflexology Conclusion References Editorial. The Placebo in Medicine. Medical Press, 18 June
1890: 642. |
The Drug Industry’s Chokehold on America’s Health Care
By Joanne Laurier
3 January 2005
"The Truth About the Drug Companies: How They Deceive us and What to do
About It"
By Marcia Angell M.D., published by Random House, 304 pp;
"Overdosed America: the Broken Promise of American Medicine",
By John Abramson, M.D., published by Harper Collins, 332 pp.
Major pharmaceutical companies have been hit recently by an array of
scandals regarding the safety of certain “ blockbuster” drugs. Merck’s
Vioxx, a leading arthritis and pain medication was withdrawn from the
Market after it was shown to have caused thousands of heart attacks and an
estimated 55,000 deaths. Its leading competitor, Celebrex, manufactured
by Pfizer, faces similar difficulties.
Other drugs, including over-the-counter remedies, are also being
Scrutinized for severe, unwanted side-effects. On December 18 the Detroit Free
Press released its own analysis concluding that many thousands of Americans
Are getting sick and dying from prescription drugs prematurely entering the
market.
Two recently-published books provide valuable insights and describe in
devastating detail the operations of the pharmaceutical industry—the
consequences of its domination of government agencies and the medical
establishment. The Truth About the Drug Companies: How They Deceive Us
And What To Do About It is written by Marcia Angell, M.D.; Overdosed
America: The Broken Promise of American Medicine is authored by John Abramson,
M.D.
A former editor-in-chief of the New England Journal of Medicine (NEJM),
Angell witnessed the work of that prestigious journal come increasingly
under the influence of the drug industry. She claims in the volume’s
introduction that the pharmaceuticals began exercising “a level of
control over the way research is done that was unheard of when I first came to
the journal, and the aim was clearly to load the dice to make sure their
drugs looked good.” (p. xviii)
The author of Overdosed America, Abramson, is a family doctor on the
clinical faculty of Harvard Medical School. He was prompted to write
his book because of what he perceived as the corporate takeover of medical
research. Trained as a statistician, he “ researched the research,” and
found that “even the most respected medical journals seemed more like
infomercials whose purpose was to promote their sponsors’ products
rather than to search for the best ways to improve people’s health.” (p. xii)
The most profitable industry
Americans spend a staggering $200 billion a year on prescription drugs
Out of worldwide sales of $400 billion. From 1980 to 2000, prescription
Drugs tripled as a percentage of US gross domestic product. Since that time,
PhRMA—the Pharmaceutical Research and Manufacturers of America—has
consistently ranked by far as the most profitable industry, while its
CEOs have raked in eight digit salaries combined with eight digit stock
options. In 2002, the combined profits of the 10 drug companies in the Fortune
500 ($35.9 billion) were MORE than the total profits of the OTHER 490
Businesses ($33.7 billion) !!
Both Angell and Abramson contend that PhRMA began its astronomical rise
In the late 1970s and early 1980s—particularly under Ronald Reagan. In
1980, Congress enacted a series of laws, such as the Bayh-Dole Act (Senator
Birch Bayh [D-Indiana] and Senator Robert Dole [R-Kansas]) that enabled
universities and small companies to patent discoveries made through
publicly funded research and then grant exclusive licenses to drug companies.
Until that time, taxpayer-financed research was public property available to
Any company. The nascent biotech industry was thus given a tremendous
boost. Through similar legislation, the National Institutes of Health
(NIH)—the major distributor of tax dollars for medical research—was permitted to
Enter into deals that would directly transfer NIH discoveries to industry.
As Angell points out: “These laws mean that drug companies no longer
have to rely on their own research for new drugs, and few of the large ones do.
Increasingly, they rely on academia, small biotech start-up companies,
And the NIH for that.” (p. 8) This, argues Angell, has changed the ethos of
medical schools and teaching hospitals, who now see themselves as
partners of industry and become “just as enthusiastic as any entrepreneur about
the opportunities to parlay their discoveries into financial gain.” (p. 8)
She cites the example of the Dana-Farber Cancer Institute, a Harvard
hospital, which has a deal with the drug company Novartis, giving it rights to
discoveries that lead to new cancer drugs.
In 1984, the Hatch-Waxman Act extended monopoly rights for brand-name
drugs—drugs for which the manufacturer has marketing exclusivity.
(After brand-marketing rights expire on a drug, generic copies can be produced
By any manufacturer for a fraction of the cost. The monopoly status of a
brand-name drug also translates into an exorbitant selling price by
comparison with its generic equivalent.) Other congressional laws
enacted in the 1990s have increased the patent life of brand-name drugs from 8
years in 1980 to 14 years in 2000.
In 1992 Congress passed the landmark Prescription Drug User Fee Act,
effectively putting the Food and Drug Administration (FDA) on the
pharmaceutical industry’s payroll, according to Angell. To expedite
approval of drugs, the law authorized drug companies to pay user fees to the
FDA, making the governmental agency dependent on the industry it regulates.
Today, industry-paid FDA employees constitute more than half of the
agency’s staff involved in approving drugs. The FDA now generally approves drugs
faster than counterpart agencies anywhere in the world. Since the law
was enacted, 13 prescription drugs, causing hundreds of deaths, have had to
be withdrawn from the market.
The FDA
The origin of the FDA is not discussed extensively by either Angell or
Abramson, but a brief historical review would be in order. The agency
Was established in 1906, by the Food and Drug Act, partially in response to
exposures such as muckraker Upton Sinclair’s famous novel, The Jungle,
treating the appalling conditions in Chicago’s slaughterhouses.
Several medical disasters in 1937 and 1938 compelled President Franklin
Roosevelt to sign the Food, Drug and Cosmetic Act of 1938, which
Brought cosmetics and medical devices under government control and required
That drugs be labeled with adequate directions for safe use. The quarter
Century that followed the 1938 bill saw a vast expansion of the pharmaceutical
industry. As science matured and patent laws changed—making possible
the profitable control of a drug by the company that owned it—the industry
discovered, developed and marketed drugs, some of which no doubt had
important value in treating disease.
Drug companies also used the 1938 law to devise the concept of
Prescription drugs—drugs available only through physicians at a price set by the
companies.
Anti-regulatory action began under the Carter administration, but
Reagan slashed the FDA’s enforcement budgets in earnest. The routine actions
By which the agency kept contaminated foods and problem drugs off the
market—seizures, injunctions and prosecutions—dropped dramatically. The
limits of the FDA budget paved the way for the 1992 bill, which provided
additional funds for the agency—by putting it at the service of the
pharmaceutical industry.
Bringing the companies into the drug approval process was vital for the
pharmaceuticals because patents on new drugs are usually obtained
before clinical testing begins, thereby eating into a drug’s 20-year patent
life—the time it can be sold without competition. To maximize
profitability, the drug companies are under pressure to shorten the trials so that
marketing the drug can get underway.
The truth about research and development
As public opposition to rapacious drug pricing has grown, Angell
Reveals that the industry’s media campaign to counter this centers on its
claims to be innovative. “Big pharma likes to refer to itself as a
‘research-based industry,’ but it is hardly that.”(p. 73) In reality, the budget of the
Drug companies for research and development is dwarfed by massive marketing
expenditures. Only a handful of important drugs have been developed—mostly
based on taxpayer-funded research—in recent years. (R&D costs are tax-deductible.) This, despite the fact that the number of clinical trials under way in any given year is staggering. In 2001, about 2.3 million American were involved in an estimated 80,000 studies.
“The great majority of ‘new’ drugs are not new at all but merely
Variations of older drugs already on the market. These are called ‘me-too’ drugs.
The idea is to grab a share of the established, lucrative market by
Producing something very similar to a top-selling drug,” (p. xvi) writes Angell.
For example, there are six cholesterol-lowering drugs (Mevacor, Lipitor,
Zocor, Pravachol, Lescol and the newest, Crestor). She continues: “But instead
Of investing more in innovative drugs and moderating prices, drug
companies are pouring money into marketing, legal maneuvers to extend patent rights,
and government lobbying to prevent any form of price regulation.” (p. xix)
In 2002, of the 78 drugs approved by the FDA, only 17 contained new
Active ingredients and only 7 were classified as improvements over their older
versions. Consequently, trouble may be looming for PhRMA. Some of the
top-selling drugs, representing combined sales of some $35 billion a
year, are scheduled to go off patent within a few years of each other.
Pharmaceuticals also extend the life of a blockbuster drug that is
going off patent by creating another drug just different enough to qualify for a
new patent and then shifting users to the new drug. AstraZenaca’s Nexium, a
revamped version of the company’s older drug, Prilosec, is a case in
point. Shortly before the patent for Prilosec was set to expire, the FDA
approved Nexium, which became the most heavily advertised drug in the US.
“Today’s purple pill is Nexium, from the makers of Prilosec,” became a
well-aired sound bite. After Nexium sales outstripped Prilosec’s, the latter
became a non-prescription drug, selling for a fraction of Nexium’s cost.
The market for existing drugs is also expanded by redefining what
constitutes medical need or illness. For example, the cutoff for high
cholesterol has been lowered over the years, from more than 280
milligrams per deciliter to 240 and now to below 200. Although many doctors will
recommend diet and exercise to achieve that level, it may be easier for
the patient to take a prescription. The expansion of the definition
increases the demand for medication by millions of customers. The
cholesterol-lowering drug Lipitor was the top-selling drug in the world in 2002, followed by
its competitor Zocor. Similar processes are at work with remedies for other
ailments, such as hypertension.
Shortage of life-saving drugs
While me-too, or copycat, drugs flood the market—proliferating in many
Cases because of an industry-created demand—there are growing shortages for
life-saving medicines, as companies try to free production capacity for
drugs with bigger market potential. Angell reports that in 2001 there
were serious shortages of drugs to treat premature infants, antidotes for
certain drug overdoses, and an anti-clotting drug for hemophilia, as well as
drugs used for cardiac resuscitation and gonorrhea and vaccines against flu
and pneumonia, among other much-needed remedies. This season’s flu vaccine
shortage in the US imperiled thousands of high-risk sections of the
population, including the elderly, children, pregnant women and those
with chronic and life-threatening diseases such as cancer.
The situation is particularly stark in relation to the development of
Drugs for life-threatening diseases common in underdeveloped countries. In
contrast to the cornucopia of drugs to treat erectile dysfunction, mood
disorders, hay fever and heartburn, the pharmaceuticals are largely
uninterested in developing drugs to treat widespread tropical diseases
like malaria. Under the Clinton administration, the pharmaceuticals
vehemently opposed South Africa’s threat to produce or import generic drugs to
control its raging HIV/AIDS epidemic. While the Clinton administration was
eventually forced to back off from its warning of trade sanctions at
the behest of the drug industry, the Bush administration stood alone among
143 World Trade Organization countries in opposing the relaxation of patent
protection for HIV/AIDS medicines for Third World countries.
Marketing a drug
Angell cites some of the more egregious examples of direct-to-consumer
(DTC) advertising. DTC was made legal in 1981 and extended in 1997 by
Allowing that only major side effects and contraindications had to be included
in the media ads. The sky was then the limit: GlaxoSmithKline and its
co-marketer Bayer signed a deal with the National Football League to promote
Levitra, the me-too erectile dysfunction competitor of Viagra. Angell quips: “In
fact, to watch the 2004 Super Bowl was to wonder whether football
causes erectile dysfunction.” (p. 116) Pfizer, the maker of Viagra, then
phased out its old and tired promoter Bob Dole in favor of baseball star Rafael
Palmeiro. The company also sponsors a Viagra car on the NASCAR circuit.
The explosion of drug ads in the 1990s coincided with the transition of
Many Americans to HMO-type health plans that covered the cost of
Prescription drugs. Researchers from Dartmouth Medical School found, among other
things, that two out of five ads attempted to medicalize ordinary life issues.
(“Routine hair loss or a runny nose, for example, became a medical
Problem requiring treatment with expensive prescription drugs.” p. 154) Not
only was advertising a boon for the drug industry, but it has also become the
financial staple of many media outlets; most medical journals are also
dependent on drug ads for survival. DTC ads are prohibited in every
other advanced capitalist country except New Zealand.
Angell asks: “If prescription drugs are so good why do they have to be
pushed so hard?... Important new drugs require very little marketing.
Me-too drugs, by contrast, require relentless flogging, because companies need
To persuade doctors and the public that there is some reason to prescribe
One instead of another.” (p. 133) Or perhaps instead of a far-cheaper,
over-the-counter drug with equal or better benefits.
Big advertising agencies have become involved in the PhRMA
direct-to-consumer advertising bonanza. Madison Avenue giants such as
Omnicom, WPP and Interpublic are cashing in. Omnicom owns a medical
education and communication company that ghostwrote the articles that
turned Neurontin, a drug originally approved for a very limited use affecting
only around 250,000 people, into a blockbuster taken by millions. This was
accomplished by marketing the drug for unapproved (“off-label”) uses.
Angell notes that such practices are illegal.
Covering all bases, the pharmaceutical companies also fund a major
Portion of the costs of continuing medical education for physicians. They
financially endow the meetings of professional organizations, such as
the American College of Cardiology and the American Society of Hematology,
where much of the continuing education for doctors takes place. This is
combined with the $11 billion worth of “free samples” the drug companies gave
doctors in 2001.
Marketing a disease
“Marketing a disease is the best way to market a drug,” notes the
well-known breast cancer expert, Dr. Susan Love. Abramson quotes Love in Overdosed
America in regard to the marketing of Premarin, a hormone replacement
therapy (HRT) drug. In an attempt to overcome bad publicity that linked
the drug to cancer in 1975, Premarin was rehabilitated as a drug to prevent
osteoporosis. With the help of the National Osteoporosis Foundation and
a New England Journal of Medicine report on the positive effects of
estrogen on heart disease, Premarin sales in 1992 once again soared to their
1975 levels. One out of five postmenopausal women in the US was taking
hormones. Premarin use increased another 40 percent over the next three years and
in 1995 became the most frequently prescribed brand-name drug in the US.
In 1998, the results of the first randomized controlled clinical trial
Of HRT were published, establishing that HRT increased women’s risk of
Heart disease by 50 percent. Despite this, Premarin was still the third most
frequently prescribed drug in the country. Premarin’s demise came with
the well-publicized Million Women Study in 2003.
Abramson writes: “Twenty million American women have taken HRT not only
To relieve symptoms such as hot flashes and vaginal dryness but also
Believing that hormones would protect their hearts, decrease Alzheimer’s and
Parkinson’s disease, prevent tooth loss and diabetes, strengthen their
bones, preserve sexual function and urinary continence, improve the
quality of their lives, and increase their longevity. The women who took HRT
had access to the best care that American medicine had to offer: Compared
with the population at large, they were more likely to have graduated from
college, were wealthier, and were more likely to have received
preventative care. Despite this, they unwittingly exposed themselves to increased
risks of breast cancer, heart attack, stroke, Alzheimer’s disease and blood
clots.” (pp. 70-71)
Related to this development is the marketing of drugs for
osteoporosis—a disease whose risks were largely unknown until the HRT educational
campaign was initiated in 1982. Drugs such as Fosamax and Actonel became
approved by the FDA. However, a 2001 study in NEJM showed that even women with
severe osteoporosis derived only small benefit from these drugs. Although
these drugs increase the score on bone-density tests, they do not necessarily
contribute proportionately to fracture resistance. This is because the
new bone, as a result of taking the osteoporosis drugs, is formed primarily
on the cortical bone—the outer part of the bone. Neither drug affects the
locations of the body that have an internal structure of trabecular
bone, bone that provides additional strength in areas of the skeleton most
vulnerable to fracture, such as hips, wrists and spine.
“In the final analysis,” argues Abramson, “the ‘disease’ of age-related
osteoporosis is not a disease at all, but the quintessential example of
successful ‘disease mongering.’ The drug industry has succeeded in
planting the fear that bones will suddenly and without warning ‘snap’ in women
who had naively believed they were healthy.” (p. 219) He further states:
“The net effect of drug treatment on the risk of serious illness in the
Highest risk women? Nothing—except the cost of the drug” (p. 214). Citing the
NIH’s Study of Osteoporotic Fractures, the author reveals that regular
Exercise achieved twice the reduction in hip fractures compared to Fosamax use
In women over 65.
One of the most serious risks attendant on the commercialization of
medicine, according to both Angell and Abramson, is “polypharmacy,” the
taking of several prescriptions at once. Both authors point out that
very few drugs have only one side effect. Besides the real possibility of
drug interactions, multiple drug taking likely leads to one of the drugs
interfering with organ function. It would be extremely difficult to
gauge with complete accuracy the implications of all the various side
effects—short term and long term—of multiple prescriptions on an
individual. Drug testing is generally not slanted to produce such an evaluation. In
any event, multiple prescription takers don’t all imbibe the same drug
cocktails.
Bush’s prescription drug plan
Drug company lobbyists, doling out tens of millions of dollars, are
extremely well connected to both Republicans and Democrats. Drug
company influence reaches deep into the Bush administration. Defense Secretary
Donald Rumsfeld was CEO, president and chairman of G.D. Searle, a major
Drug firm that merged with Pharmacia and was then bought out by Pfizer. The
Elder George Bush was on Eli Lilly’s board of directors before becoming
president. The 2003 meeting of PhRMA featured Bush the elder, Secretary of Health
and Human Services Tommy Thompson, former FDA Commissioner Mark McClellan
and the chairman of the Republican Senatorial Campaign Committee, Senator
George Allen (R-Va.).
Last year, former FDA chief McClellan, brother of White House press
secretary Scott McClellan, delivered a speech in Mexico in which he
excoriated other countries for regulating drug prices, demanding that
the gap between the high costs of drugs in the US and those of other
countries be bridged by other countries raising their own drug prices.
“The heavy hand of big pharma is felt at all levels of government.
Nothing demonstrates that influence more plainly than the prescription drug
Benefit added to Medicare in late 2003,” writes Angell in The Truth About the
Drug Companies. (p. 193) Described by both authors as a gargantuan bonanza
For PhRMA, the Medicare “reform” is dealt with in more detail by Abramson.
He notes that not only will the drug plan cost seniors more money (an
Average Medicare recipient who spent $2,318 out-of-pocket for prescription
drugs in 2003 will spend $2,911 in 2007), but the bill also specifically
prohibits the federal government from negotiating prices with drug manufacturers.
PhRMA also helped defeat an amendment that would have funded research
To determine which drugs actually provide safe and effective treatment—a
worthwhile endeavor considering that 3 of the top 15 drugs most
frequently prescribed for American seniors in 2003 were Celebrex, Vioxx and
Fosamax!
Solutions
While "The Truth About the Drug Companies" and "Overdosed America" have
their independent areas of focus, there is much overlapping material.
The contamination of science and the scientific process is a theme
Seriously addressed by both Angell and Abramson. Unfortunately, their works
Confirm that an in-depth analysis does not automatically lead to adequate
conclusions.
Angell’s book ends with a whimper not a bang as she promotes the notion
That “most of the changes could be achieved with simple congressional
legislation.” Although she does mention that the pharmaceutical
industry should be “regarded much as a public utility,” demanding that its books
be opened, her basic advice is to strengthen the FDA; require that new
drugs be compared not just with placebos but with older drugs for the same
ailments; curb monopoly marketing rights; and prohibit direct-to-consumer
advertising. As is often the case these days with many such powerful exposés, the
ensuing recommendations appear as an impotent wish list attached to the faint
hope that the powers-that-be can be persuaded to take the moral high ground
and eliminate their anti-social excesses.
On a somewhat different note, Abramson correctly states that the
failure of the market to serve American’s medical needs is not a “market failure,
but a market success.” He adds: “Drug companies earn higher profits when more
people use expensive drugs, not when people achieve better health. Doctors
and hospitals are paid more for doing more, largely without regard for
evidence of improved health outcomes.... Health care providers that deliver
high quality, efficient care are financially penalized for not delivering a
higher volume of more intensive services, beneficial or not (referred
to as the ‘perverse incentive’).” He goes to on to say that “American
politics, science, and health care has created an imbalance between corporate
goals and public interest that is no longer self-correcting. In, fact, it was
become resistant to correction”. (pp. 254-256).
An advocate of universal health care, Abramson pushes for his version
Of reforming the system. He believes that extending coverage to the
Uninsured would trigger a demand for accountability from industry and government,
thereby resurrecting the medical watchdogs. If Americans would stop thinking
that universal health care is “un-American,” then commerce and the state
would fall into line.
In fact, extricating medical science from the clutches of the conglomerates
is bound up with a far greater social transformation, which requires
changes in the foundations of the present system. The present disastrous state
of health care in America is the logical outcome of a medical system
entirely subordinated to profit, with no attention on health. Protest and public
awareness will not halt the process, nor will futile appeals to a bought-and-sold Congress.
Despite their limitations, "The Truth About the Drug Companies" and
"Overdosed America" draw a disturbing picture of the inhuman character
Of production-for-profit in the medical sphere. The books are an important
contribution to exposing the utter incompatibility of the present state of
affairs with the health and welfare of the population.
The Drug Industry’s Chokehold on America’s Health Care
By Joanne Laurier
3 January 2005
"The Truth About the Drug Companies: How They Deceive us and What to do
About It"
By Marcia Angell M.D., published by Random House, 304 pp;
"Overdosed America: the Broken Promise of American Medicine",
By John Abramson, M.D., published by Harper Collins, 332 pp.
Major pharmaceutical companies have been hit recently by an array of
scandals regarding the safety of certain “ blockbuster” drugs. Merck’s
Vioxx, a leading arthritis and pain medication was withdrawn from the
Market after it was shown to have caused thousands of heart attacks and an
estimated 55,000 deaths. Its leading competitor, Celebrex, manufactured
by Pfizer, faces similar difficulties.
Other drugs, including over-the-counter remedies, are also being
Scrutinized for severe, unwanted side-effects. On December 18 the Detroit Free
Press released its own analysis concluding that many thousands of Americans
Are getting sick and dying from prescription drugs prematurely entering the
market.
Two recently-published books provide valuable insights and describe in
devastating detail the operations of the pharmaceutical industry—the
consequences of its domination of government agencies and the medical
establishment. The Truth About the Drug Companies: How They Deceive Us
And What To Do About It is written by Marcia Angell, M.D.; Overdosed
America: The Broken Promise of American Medicine is authored by John Abramson,
M.D.
A former editor-in-chief of the New England Journal of Medicine (NEJM),
Angell witnessed the work of that prestigious journal come increasingly
under the influence of the drug industry. She claims in the volume’s
introduction that the pharmaceuticals began exercising “a level of
control over the way research is done that was unheard of when I first came to
the journal, and the aim was clearly to load the dice to make sure their
drugs looked good.” (p. xviii)
The author of Overdosed America, Abramson, is a family doctor on the
clinical faculty of Harvard Medical School. He was prompted to write
his book because of what he perceived as the corporate takeover of medical
research. Trained as a statistician, he “ researched the research,” and
found that “even the most respected medical journals seemed more like
infomercials whose purpose was to promote their sponsors’ products
rather than to search for the best ways to improve people’s health.” (p. xii)
The most profitable industry
Americans spend a staggering $200 billion a year on prescription drugs
Out of worldwide sales of $400 billion. From 1980 to 2000, prescription
Drugs tripled as a percentage of US gross domestic product. Since that time,
PhRMA—the Pharmaceutical Research and Manufacturers of America—has
consistently ranked by far as the most profitable industry, while its
CEOs have raked in eight digit salaries combined with eight digit stock
options. In 2002, the combined profits of the 10 drug companies in the Fortune
500 ($35.9 billion) were MORE than the total profits of the OTHER 490
Businesses ($33.7 billion) !!
Both Angell and Abramson contend that PhRMA began its astronomical rise
In the late 1970s and early 1980s—particularly under Ronald Reagan. In
1980, Congress enacted a series of laws, such as the Bayh-Dole Act (Senator
Birch Bayh [D-Indiana] and Senator Robert Dole [R-Kansas]) that enabled
universities and small companies to patent discoveries made through
publicly funded research and then grant exclusive licenses to drug companies.
Until that time, taxpayer-financed research was public property available to
Any company. The nascent biotech industry was thus given a tremendous
boost. Through similar legislation, the National Institutes of Health
(NIH)—the major distributor of tax dollars for medical research—was permitted to
Enter into deals that would directly transfer NIH discoveries to industry.
As Angell points out: “These laws mean that drug companies no longer
have to rely on their own research for new drugs, and few of the large ones do.
Increasingly, they rely on academia, small biotech start-up companies,
And the NIH for that.” (p. 8) This, argues Angell, has changed the ethos of
medical schools and teaching hospitals, who now see themselves as
partners of industry and become “just as enthusiastic as any entrepreneur about
the opportunities to parlay their discoveries into financial gain.” (p. 8)
She cites the example of the Dana-Farber Cancer Institute, a Harvard
hospital, which has a deal with the drug company Novartis, giving it rights to
discoveries that lead to new cancer drugs.
In 1984, the Hatch-Waxman Act extended monopoly rights for brand-name
drugs—drugs for which the manufacturer has marketing exclusivity.
(After brand-marketing rights expire on a drug, generic copies can be produced
By any manufacturer for a fraction of the cost. The monopoly status of a
brand-name drug also translates into an exorbitant selling price by
comparison with its generic equivalent.) Other congressional laws
enacted in the 1990s have increased the patent life of brand-name drugs from 8
years in 1980 to 14 years in 2000.
In 1992 Congress passed the landmark Prescription Drug User Fee Act,
effectively putting the Food and Drug Administration (FDA) on the
pharmaceutical industry’s payroll, according to Angell. To expedite
approval of drugs, the law authorized drug companies to pay user fees to the
FDA, making the governmental agency dependent on the industry it regulates.
Today, industry-paid FDA employees constitute more than half of the
agency’s staff involved in approving drugs. The FDA now generally approves drugs
faster than counterpart agencies anywhere in the world. Since the law
was enacted, 13 prescription drugs, causing hundreds of deaths, have had to
be withdrawn from the market.
The FDA
The origin of the FDA is not discussed extensively by either Angell or
Abramson, but a brief historical review would be in order. The agency
Was established in 1906, by the Food and Drug Act, partially in response to
exposures such as muckraker Upton Sinclair’s famous novel, The Jungle,
treating the appalling conditions in Chicago’s slaughterhouses.
Several medical disasters in 1937 and 1938 compelled President Franklin
Roosevelt to sign the Food, Drug and Cosmetic Act of 1938, which
Brought cosmetics and medical devices under government control and required
That drugs be labeled with adequate directions for safe use. The quarter
Century that followed the 1938 bill saw a vast expansion of the pharmaceutical
industry. As science matured and patent laws changed—making possible
the profitable control of a drug by the company that owned it—the industry
discovered, developed and marketed drugs, some of which no doubt had
important value in treating disease.
Drug companies also used the 1938 law to devise the concept of
Prescription drugs—drugs available only through physicians at a price set by the
companies.
Anti-regulatory action began under the Carter administration, but
Reagan slashed the FDA’s enforcement budgets in earnest. The routine actions
By which the agency kept contaminated foods and problem drugs off the
market—seizures, injunctions and prosecutions—dropped dramatically. The
limits of the FDA budget paved the way for the 1992 bill, which provided
additional funds for the agency—by putting it at the service of the
pharmaceutical industry.
Bringing the companies into the drug approval process was vital for the
pharmaceuticals because patents on new drugs are usually obtained
before clinical testing begins, thereby eating into a drug’s 20-year patent
life—the time it can be sold without competition. To maximize
profitability, the drug companies are under pressure to shorten the trials so that
marketing the drug can get underway.
The truth about research and development
As public opposition to rapacious drug pricing has grown, Angell
Reveals that the industry’s media campaign to counter this centers on its
claims to be innovative. “Big pharma likes to refer to itself as a
‘research-based industry,’ but it is hardly that.”(p. 73) In reality, the budget of the
Drug companies for research and development is dwarfed by massive marketing
expenditures. Only a handful of important drugs have been developed—mostly
based on taxpayer-funded research—in recent years. (R&D costs are tax-deductible.) This, despite the fact that the number of clinical trials under way in any given year is staggering. In 2001, about 2.3 million American were involved in an estimated 80,000 studies.
“The great majority of ‘new’ drugs are not new at all but merely
Variations of older drugs already on the market. These are called ‘me-too’ drugs.
The idea is to grab a share of the established, lucrative market by
Producing something very similar to a top-selling drug,” (p. xvi) writes Angell.
For example, there are six cholesterol-lowering drugs (Mevacor, Lipitor,
Zocor, Pravachol, Lescol and the newest, Crestor). She continues: “But instead
Of investing more in innovative drugs and moderating prices, drug
companies are pouring money into marketing, legal maneuvers to extend patent rights,
and government lobbying to prevent any form of price regulation.” (p. xix)
In 2002, of the 78 drugs approved by the FDA, only 17 contained new
Active ingredients and only 7 were classified as improvements over their older
versions. Consequently, trouble may be looming for PhRMA. Some of the
top-selling drugs, representing combined sales of some $35 billion a
year, are scheduled to go off patent within a few years of each other.
Pharmaceuticals also extend the life of a blockbuster drug that is
going off patent by creating another drug just different enough to qualify for a
new patent and then shifting users to the new drug. AstraZenaca’s Nexium, a
revamped version of the company’s older drug, Prilosec, is a case in
point. Shortly before the patent for Prilosec was set to expire, the FDA
approved Nexium, which became the most heavily advertised drug in the US.
“Today’s purple pill is Nexium, from the makers of Prilosec,” became a
well-aired sound bite. After Nexium sales outstripped Prilosec’s, the latter
became a non-prescription drug, selling for a fraction of Nexium’s cost.
The market for existing drugs is also expanded by redefining what
constitutes medical need or illness. For example, the cutoff for high
cholesterol has been lowered over the years, from more than 280
milligrams per deciliter to 240 and now to below 200. Although many doctors will
recommend diet and exercise to achieve that level, it may be easier for
the patient to take a prescription. The expansion of the definition
increases the demand for medication by millions of customers. The
cholesterol-lowering drug Lipitor was the top-selling drug in the world in 2002, followed by
its competitor Zocor. Similar processes are at work with remedies for other
ailments, such as hypertension.
Shortage of life-saving drugs
While me-too, or copycat, drugs flood the market—proliferating in many
Cases because of an industry-created demand—there are growing shortages for
life-saving medicines, as companies try to free production capacity for
drugs with bigger market potential. Angell reports that in 2001 there
were serious shortages of drugs to treat premature infants, antidotes for
certain drug overdoses, and an anti-clotting drug for hemophilia, as well as
drugs used for cardiac resuscitation and gonorrhea and vaccines against flu
and pneumonia, among other much-needed remedies. This season’s flu vaccine
shortage in the US imperiled thousands of high-risk sections of the
population, including the elderly, children, pregnant women and those
with chronic and life-threatening diseases such as cancer.
The situation is particularly stark in relation to the development of
Drugs for life-threatening diseases common in underdeveloped countries. In
contrast to the cornucopia of drugs to treat erectile dysfunction, mood
disorders, hay fever and heartburn, the pharmaceuticals are largely
uninterested in developing drugs to treat widespread tropical diseases
like malaria. Under the Clinton administration, the pharmaceuticals
vehemently opposed South Africa’s threat to produce or import generic drugs to
control its raging HIV/AIDS epidemic. While the Clinton administration was
eventually forced to back off from its warning of trade sanctions at
the behest of the drug industry, the Bush administration stood alone among
143 World Trade Organization countries in opposing the relaxation of patent
protection for HIV/AIDS medicines for Third World countries.
Marketing a drug
Angell cites some of the more egregious examples of direct-to-consumer
(DTC) advertising. DTC was made legal in 1981 and extended in 1997 by
Allowing that only major side effects and contraindications had to be included
in the media ads. The sky was then the limit: GlaxoSmithKline and its
co-marketer Bayer signed a deal with the National Football League to promote
Levitra, the me-too erectile dysfunction competitor of Viagra. Angell quips: “In
fact, to watch the 2004 Super Bowl was to wonder whether football
causes erectile dysfunction.” (p. 116) Pfizer, the maker of Viagra, then
phased out its old and tired promoter Bob Dole in favor of baseball star Rafael
Palmeiro. The company also sponsors a Viagra car on the NASCAR circuit.
The explosion of drug ads in the 1990s coincided with the transition of
Many Americans to HMO-type health plans that covered the cost of
Prescription drugs. Researchers from Dartmouth Medical School found, among other
things, that two out of five ads attempted to medicalize ordinary life issues.
(“Routine hair loss or a runny nose, for example, became a medical
Problem requiring treatment with expensive prescription drugs.” p. 154) Not
only was advertising a boon for the drug industry, but it has also become the
financial staple of many media outlets; most medical journals are also
dependent on drug ads for survival. DTC ads are prohibited in every
other advanced capitalist country except New Zealand.
Angell asks: “If prescription drugs are so good why do they have to be
pushed so hard?... Important new drugs require very little marketing.
Me-too drugs, by contrast, require relentless flogging, because companies need
To persuade doctors and the public that there is some reason to prescribe
One instead of another.” (p. 133) Or perhaps instead of a far-cheaper,
over-the-counter drug with equal or better benefits.
Big advertising agencies have become involved in the PhRMA
direct-to-consumer advertising bonanza. Madison Avenue giants such as
Omnicom, WPP and Interpublic are cashing in. Omnicom owns a medical
education and communication company that ghostwrote the articles that
turned Neurontin, a drug originally approved for a very limited use affecting
only around 250,000 people, into a blockbuster taken by millions. This was
accomplished by marketing the drug for unapproved (“off-label”) uses.
Angell notes that such practices are illegal.
Covering all bases, the pharmaceutical companies also fund a major
Portion of the costs of continuing medical education for physicians. They
financially endow the meetings of professional organizations, such as
the American College of Cardiology and the American Society of Hematology,
where much of the continuing education for doctors takes place. This is
combined with the $11 billion worth of “free samples” the drug companies gave
doctors in 2001.
Marketing a disease
“Marketing a disease is the best way to market a drug,” notes the
well-known breast cancer expert, Dr. Susan Love. Abramson quotes Love in Overdosed
America in regard to the marketing of Premarin, a hormone replacement
therapy (HRT) drug. In an attempt to overcome bad publicity that linked
the drug to cancer in 1975, Premarin was rehabilitated as a drug to prevent
osteoporosis. With the help of the National Osteoporosis Foundation and
a New England Journal of Medicine report on the positive effects of
estrogen on heart disease, Premarin sales in 1992 once again soared to their
1975 levels. One out of five postmenopausal women in the US was taking
hormones. Premarin use increased another 40 percent over the next three years and
in 1995 became the most frequently prescribed brand-name drug in the US.
In 1998, the results of the first randomized controlled clinical trial
Of HRT were published, establishing that HRT increased women’s risk of
Heart disease by 50 percent. Despite this, Premarin was still the third most
frequently prescribed drug in the country. Premarin’s demise came with
the well-publicized Million Women Study in 2003.
Abramson writes: “Twenty million American women have taken HRT not only
To relieve symptoms such as hot flashes and vaginal dryness but also
Believing that hormones would protect their hearts, decrease Alzheimer’s and
Parkinson’s disease, prevent tooth loss and diabetes, strengthen their
bones, preserve sexual function and urinary continence, improve the
quality of their lives, and increase their longevity. The women who took HRT
had access to the best care that American medicine had to offer: Compared
with the population at large, they were more likely to have graduated from
college, were wealthier, and were more likely to have received
preventative care. Despite this, they unwittingly exposed themselves to increased
risks of breast cancer, heart attack, stroke, Alzheimer’s disease and blood
clots.” (pp. 70-71)
Related to this development is the marketing of drugs for
osteoporosis—a disease whose risks were largely unknown until the HRT educational
campaign was initiated in 1982. Drugs such as Fosamax and Actonel became
approved by the FDA. However, a 2001 study in NEJM showed that even women with
severe osteoporosis derived only small benefit from these drugs. Although
these drugs increase the score on bone-density tests, they do not necessarily
contribute proportionately to fracture resistance. This is because the
new bone, as a result of taking the osteoporosis drugs, is formed primarily
on the cortical bone—the outer part of the bone. Neither drug affects the
locations of the body that have an internal structure of trabecular
bone, bone that provides additional strength in areas of the skeleton most
vulnerable to fracture, such as hips, wrists and spine.
“In the final analysis,” argues Abramson, “the ‘disease’ of age-related
osteoporosis is not a disease at all, but the quintessential example of
successful ‘disease mongering.’ The drug industry has succeeded in
planting the fear that bones will suddenly and without warning ‘snap’ in women
who had naively believed they were healthy.” (p. 219) He further states:
“The net effect of drug treatment on the risk of serious illness in the
Highest risk women? Nothing—except the cost of the drug” (p. 214). Citing the
NIH’s Study of Osteoporotic Fractures, the author reveals that regular
Exercise achieved twice the reduction in hip fractures compared to Fosamax use
In women over 65.
One of the most serious risks attendant on the commercialization of
medicine, according to both Angell and Abramson, is “polypharmacy,” the
taking of several prescriptions at once. Both authors point out that
very few drugs have only one side effect. Besides the real possibility of
drug interactions, multiple drug taking likely leads to one of the drugs
interfering with organ function. It would be extremely difficult to
gauge with complete accuracy the implications of all the various side
effects—short term and long term—of multiple prescriptions on an
individual. Drug testing is generally not slanted to produce such an evaluation. In
any event, multiple prescription takers don’t all imbibe the same drug
cocktails.
The Drug Industry’s Chokehold on America’s Health Care
By Joanne Laurier
3 January 2005
"The Truth About the Drug Companies: How They Deceive us and What to do
About It"
By Marcia Angell M.D., published by Random House, 304 pp;
"Overdosed America: the Broken Promise of American Medicine",
By John Abramson, M.D., published by Harper Collins, 332 pp.
Major pharmaceutical companies have been hit recently by an array of
scandals regarding the safety of certain “ blockbuster” drugs. Merck’s
Vioxx, a leading arthritis and pain medication was withdrawn from the
Market after it was shown to have caused thousands of heart attacks and an
estimated 55,000 deaths. Its leading competitor, Celebrex, manufactured
by Pfizer, faces similar difficulties.
Other drugs, including over-the-counter remedies, are also being
Scrutinized for severe, unwanted side-effects. On December 18 the Detroit Free
Press released its own analysis concluding that many thousands of Americans
Are getting sick and dying from prescription drugs prematurely entering the
market.
Two recently-published books provide valuable insights and describe in
devastating detail the operations of the pharmaceutical industry—the
consequences of its domination of government agencies and the medical
establishment. The Truth About the Drug Companies: How They Deceive Us
And What To Do About It is written by Marcia Angell, M.D.; Overdosed
America: The Broken Promise of American Medicine is authored by John Abramson,
M.D.
A former editor-in-chief of the New England Journal of Medicine (NEJM),
Angell witnessed the work of that prestigious journal come increasingly
under the influence of the drug industry. She claims in the volume’s
introduction that the pharmaceuticals began exercising “a level of
control over the way research is done that was unheard of when I first came to
the journal, and the aim was clearly to load the dice to make sure their
drugs looked good.” (p. xviii)
The author of Overdosed America, Abramson, is a family doctor on the
clinical faculty of Harvard Medical School. He was prompted to write
his book because of what he perceived as the corporate takeover of medical
research. Trained as a statistician, he “ researched the research,” and
found that “even the most respected medical journals seemed more like
infomercials whose purpose was to promote their sponsors’ products
rather than to search for the best ways to improve people’s health.” (p. xii)
The most profitable industry
Americans spend a staggering $200 billion a year on prescription drugs
Out of worldwide sales of $400 billion. From 1980 to 2000, prescription
Drugs tripled as a percentage of US gross domestic product. Since that time,
PhRMA—the Pharmaceutical Research and Manufacturers of America—has
consistently ranked by far as the most profitable industry, while its
CEOs have raked in eight digit salaries combined with eight digit stock
options. In 2002, the combined profits of the 10 drug companies in the Fortune
500 ($35.9 billion) were MORE than the total profits of the OTHER 490
Businesses ($33.7 billion) !!
Both Angell and Abramson contend that PhRMA began its astronomical rise
In the late 1970s and early 1980s—particularly under Ronald Reagan. In
1980, Congress enacted a series of laws, such as the Bayh-Dole Act (Senator
Birch Bayh [D-Indiana] and Senator Robert Dole [R-Kansas]) that enabled
universities and small companies to patent discoveries made through
publicly funded research and then grant exclusive licenses to drug companies.
Until that time, taxpayer-financed research was public property available to
Any company. The nascent biotech industry was thus given a tremendous
boost. Through similar legislation, the National Institutes of Health
(NIH)—the major distributor of tax dollars for medical research—was permitted to
Enter into deals that would directly transfer NIH discoveries to industry.
As Angell points out: “These laws mean that drug companies no longer
have to rely on their own research for new drugs, and few of the large ones do.
Increasingly, they rely on academia, small biotech start-up companies,
And the NIH for that.” (p. 8) This, argues Angell, has changed the ethos of
medical schools and teaching hospitals, who now see themselves as
partners of industry and become “just as enthusiastic as any entrepreneur about
the opportunities to parlay their discoveries into financial gain.” (p. 8)
She cites the example of the Dana-Farber Cancer Institute, a Harvard
hospital, which has a deal with the drug company Novartis, giving it rights to
discoveries that lead to new cancer drugs.
In 1984, the Hatch-Waxman Act extended monopoly rights for brand-name
drugs—drugs for which the manufacturer has marketing exclusivity.
(After brand-marketing rights expire on a drug, generic copies can be produced
By any manufacturer for a fraction of the cost. The monopoly status of a
brand-name drug also translates into an exorbitant selling price by
comparison with its generic equivalent.) Other congressional laws
enacted in the 1990s have increased the patent life of brand-name drugs from 8
years in 1980 to 14 years in 2000.
In 1992 Congress passed the landmark Prescription Drug User Fee Act,
effectively putting the Food and Drug Administration (FDA) on the
pharmaceutical industry’s payroll, according to Angell. To expedite
approval of drugs, the law authorized drug companies to pay user fees to the
FDA, making the governmental agency dependent on the industry it regulates.
Today, industry-paid FDA employees constitute more than half of the
agency’s staff involved in approving drugs. The FDA now generally approves drugs
faster than counterpart agencies anywhere in the world. Since the law
was enacted, 13 prescription drugs, causing hundreds of deaths, have had to
be withdrawn from the market.
The FDA
The origin of the FDA is not discussed extensively by either Angell or
Abramson, but a brief historical review would be in order. The agency
Was established in 1906, by the Food and Drug Act, partially in response to
exposures such as muckraker Upton Sinclair’s famous novel, The Jungle,
treating the appalling conditions in Chicago’s slaughterhouses.
Several medical disasters in 1937 and 1938 compelled President Franklin
Roosevelt to sign the Food, Drug and Cosmetic Act of 1938, which
Brought cosmetics and medical devices under government control and required
That drugs be labeled with adequate directions for safe use. The quarter
Century that followed the 1938 bill saw a vast expansion of the pharmaceutical
industry. As science matured and patent laws changed—making possible
the profitable control of a drug by the company that owned it—the industry
discovered, developed and marketed drugs, some of which no doubt had
important value in treating disease.
Drug companies also used the 1938 law to devise the concept of
Prescription drugs—drugs available only through physicians at a price set by the
companies.
Anti-regulatory action began under the Carter administration, but
Reagan slashed the FDA’s enforcement budgets in earnest. The routine actions
By which the agency kept contaminated foods and problem drugs off the
market—seizures, injunctions and prosecutions—dropped dramatically. The
limits of the FDA budget paved the way for the 1992 bill, which provided
additional funds for the agency—by putting it at the service of the
pharmaceutical industry.
Bringing the companies into the drug approval process was vital for the
pharmaceuticals because patents on new drugs are usually obtained
before clinical testing begins, thereby eating into a drug’s 20-year patent
life—the time it can be sold without competition. To maximize
profitability, the drug companies are under pressure to shorten the trials so that
marketing the drug can get underway.
The truth about research and development
As public opposition to rapacious drug pricing has grown, Angell
Reveals that the industry’s media campaign to counter this centers on its
claims to be innovative. “Big pharma likes to refer to itself as a
‘research-based industry,’ but it is hardly that.”(p. 73) In reality, the budget of the
Drug companies for research and development is dwarfed by massive marketing
expenditures. Only a handful of important drugs have been developed—mostly
based on taxpayer-funded research—in recent years. (R&D costs are tax-deductible.)
This, despite the fact that the number of clinical trials under way in any given year is staggering.
In 2001, about 2.3 million American were involved in an estimated 80,000 studies.
“The great majority of ‘new’ drugs are not new at all but merely
Variations of older drugs already on the market. These are called ‘me-too’ drugs.
The idea is to grab a share of the established, lucrative market by
Producing something very similar to a top-selling drug,” (p. xvi) writes Angell.
For example, there are six cholesterol-lowering drugs (Mevacor, Lipitor,
Zocor, Pravachol, Lescol and the newest, Crestor). She continues: “But instead
Of investing more in innovative drugs and moderating prices, drug
companies are pouring money into marketing, legal maneuvers to extend patent rights,
and government lobbying to prevent any form of price regulation.” (p. xix)
In 2002, of the 78 drugs approved by the FDA, only 17 contained new
Active ingredients and only 7 were classified as improvements over their older
versions. Consequently, trouble may be looming for PhRMA. Some of the
top-selling drugs, representing combined sales of some $35 billion a
year, are scheduled to go off patent within a few years of each other.
Pharmaceuticals also extend the life of a blockbuster drug that is
going off patent by creating another drug just different enough to qualify for a
new patent and then shifting users to the new drug. AstraZenaca’s Nexium, a
revamped version of the company’s older drug, Prilosec, is a case in
point. Shortly before the patent for Prilosec was set to expire, the FDA
approved Nexium, which became the most heavily advertised drug in the US.
“Today’s purple pill is Nexium, from the makers of Prilosec,” became a
well-aired sound bite. After Nexium sales outstripped Prilosec’s, the latter
became a non-prescription drug, selling for a fraction of Nexium’s cost.
The market for existing drugs is also expanded by redefining what
constitutes medical need or illness. For example, the cutoff for high
cholesterol has been lowered over the years, from more than 280
milligrams per deciliter to 240 and now to below 200. Although many doctors will
recommend diet and exercise to achieve that level, it may be easier for
the patient to take a prescription. The expansion of the definition
increases the demand for medication by millions of customers. The
cholesterol-lowering drug Lipitor was the top-selling drug in the world in 2002, followed by
its competitor Zocor. Similar processes are at work with remedies for other
ailments, such as hypertension.
Shortage of life-saving drugs
While me-too, or copycat, drugs flood the market—proliferating in many
Cases because of an industry-created demand—there are growing shortages for
life-saving medicines, as companies try to free production capacity for
drugs with bigger market potential. Angell reports that in 2001 there
were serious shortages of drugs to treat premature infants, antidotes for
certain drug overdoses, and an anti-clotting drug for hemophilia, as well as
drugs used for cardiac resuscitation and gonorrhea and vaccines against flu
and pneumonia, among other much-needed remedies. This season’s flu vaccine
shortage in the US imperiled thousands of high-risk sections of the
population, including the elderly, children, pregnant women and those
with chronic and life-threatening diseases such as cancer.
The situation is particularly stark in relation to the development of
Drugs for life-threatening diseases common in underdeveloped countries. In
contrast to the cornucopia of drugs to treat erectile dysfunction, mood
disorders, hay fever and heartburn, the pharmaceuticals are largely
uninterested in developing drugs to treat widespread tropical diseases
like malaria. Under the Clinton administration, the pharmaceuticals
vehemently opposed South Africa’s threat to produce or import generic drugs to
control its raging HIV/AIDS epidemic. While the Clinton administration was
eventually forced to back off from its warning of trade sanctions at
the behest of the drug industry, the Bush administration stood alone among
143 World Trade Organization countries in opposing the relaxation of patent
protection for HIV/AIDS medicines for Third World countries.
Marketing a drug
Angell cites some of the more egregious examples of direct-to-consumer
(DTC) advertising. DTC was made legal in 1981 and extended in 1997 by
Allowing that only major side effects and contraindications had to be included
in the media ads. The sky was then the limit: GlaxoSmithKline and its
co-marketer Bayer signed a deal with the National Football League to promote
Levitra, the me-too erectile dysfunction competitor of Viagra. Angell quips: “In
fact, to watch the 2004 Super Bowl was to wonder whether football
causes erectile dysfunction.” (p. 116) Pfizer, the maker of Viagra, then
phased out its old and tired promoter Bob Dole in favor of baseball star Rafael
Palmeiro. The company also sponsors a Viagra car on the NASCAR circuit.
The explosion of drug ads in the 1990s coincided with the transition of
Many Americans to HMO-type health plans that covered the cost of
Prescription drugs. Researchers from Dartmouth Medical School found, among other
things, that two out of five ads attempted to medicalize ordinary life issues.
(“Routine hair loss or a runny nose, for example, became a medical
Problem requiring treatment with expensive prescription drugs.” p. 154) Not
only was advertising a boon for the drug industry, but it has also become the
financial staple of many media outlets; most medical journals are also
dependent on drug ads for survival. DTC ads are prohibited in every
other advanced capitalist country except New Zealand.
Angell asks: “If prescription drugs are so good why do they have to be
pushed so hard?... Important new drugs require very little marketing.
Me-too drugs, by contrast, require relentless flogging, because companies need
To persuade doctors and the public that there is some reason to prescribe
One instead of another.” (p. 133) Or perhaps instead of a far-cheaper,
over-the-counter drug with equal or better benefits.
Big advertising agencies have become involved in the PhRMA
direct-to-consumer advertising bonanza. Madison Avenue giants such as
Omnicom, WPP and Interpublic are cashing in. Omnicom owns a medical
education and communication company that ghostwrote the articles that
turned Neurontin, a drug originally approved for a very limited use affecting
only around 250,000 people, into a blockbuster taken by millions. This was
accomplished by marketing the drug for unapproved (“off-label”) uses.
Angell notes that such practices are illegal.
Covering all bases, the pharmaceutical companies also fund a major
Portion of the costs of continuing medical education for physicians. They
financially endow the meetings of professional organizations, such as
the American College of Cardiology and the American Society of Hematology,
where much of the continuing education for doctors takes place. This is
combined with the $11 billion worth of “free samples” the drug companies gave
doctors in 2001.
Marketing a disease
“Marketing a disease is the best way to market a drug,” notes the
well-known breast cancer expert, Dr. Susan Love. Abramson quotes Love in Overdosed
America in regard to the marketing of Premarin, a hormone replacement
therapy (HRT) drug. In an attempt to overcome bad publicity that linked
the drug to cancer in 1975, Premarin was rehabilitated as a drug to prevent
osteoporosis. With the help of the National Osteoporosis Foundation and
a New England Journal of Medicine report on the positive effects of
estrogen on heart disease, Premarin sales in 1992 once again soared to their
1975 levels. One out of five postmenopausal women in the US was taking
hormones. Premarin use increased another 40 percent over the next three years and
in 1995 became the most frequently prescribed brand-name drug in the US.
In 1998, the results of the first randomized controlled clinical trial
Of HRT were published, establishing that HRT increased women’s risk of
Heart disease by 50 percent. Despite this, Premarin was still the third most
frequently prescribed drug in the country. Premarin’s demise came with
the well-publicized Million Women Study in 2003.
Abramson writes: “Twenty million American women have taken HRT not only
To relieve symptoms such as hot flashes and vaginal dryness but also
Believing that hormones would protect their hearts, decrease Alzheimer’s and
Parkinson’s disease, prevent tooth loss and diabetes, strengthen their
bones, preserve sexual function and urinary continence, improve the
quality of their lives, and increase their longevity. The women who took HRT
had access to the best care that American medicine had to offer: Compared
with the population at large, they were more likely to have graduated from
college, were wealthier, and were more likely to have received
preventative care. Despite this, they unwittingly exposed themselves to increased
risks of breast cancer, heart attack, stroke, Alzheimer’s disease and blood
clots.” (pp. 70-71)
Related to this development is the marketing of drugs for
osteoporosis—a disease whose risks were largely unknown until the HRT educational
campaign was initiated in 1982. Drugs such as Fosamax and Actonel became
approved by the FDA. However, a 2001 study in NEJM showed that even women with
severe osteoporosis derived only small benefit from these drugs. Although
these drugs increase the score on bone-density tests, they do not necessarily
contribute proportionately to fracture resistance. This is because the
new bone, as a result of taking the osteoporosis drugs, is formed primarily
on the cortical bone—the outer part of the bone. Neither drug affects the
locations of the body that have an internal structure of trabecular
bone, bone that provides additional strength in areas of the skeleton most
vulnerable to fracture, such as hips, wrists and spine.
“In the final analysis,” argues Abramson, “the ‘disease’ of age-related
osteoporosis is not a disease at all, but the quintessential example of
successful ‘disease mongering.’ The drug industry has succeeded in
planting the fear that bones will suddenly and without warning ‘snap’ in women
who had naively believed they were healthy.” (p. 219) He further states:
“The net effect of drug treatment on the risk of serious illness in the
Highest risk women? Nothing—except the cost of the drug” (p. 214). Citing the
NIH’s Study of Osteoporotic Fractures, the author reveals that regular
Exercise achieved twice the reduction in hip fractures compared to Fosamax use
In women over 65.
One of the most serious risks attendant on the commercialization of
medicine, according to both Angell and Abramson, is “polypharmacy,” the
taking of several prescriptions at once. Both authors point out that
very few drugs have only one side effect. Besides the real possibility of
drug interactions, multiple drug taking likely leads to one of the drugs
interfering with organ function. It would be extremely difficult to
gauge with complete accuracy the implications of all the various side
effects—short term and long term—of multiple prescriptions on an
individual. Drug testing is generally not slanted to produce such an evaluation. In
any event, multiple prescription takers don’t all imbibe the same drug
cocktails.
Bush’s prescription drug plan
Drug company lobbyists, doling out tens of millions of dollars, are
extremely well connected to both Republicans and Democrats. Drug
company influence reaches deep into the Bush administration. Defense Secretary
Donald Rumsfeld was CEO, president and chairman of G.D. Searle, a major
Drug firm that merged with Pharmacia and was then bought out by Pfizer. The
Elder George Bush was on Eli Lilly’s board of directors before becoming
president. The 2003 meeting of PhRMA featured Bush the elder, Secretary of Health
and Human Services Tommy Thompson, former FDA Commissioner Mark McClellan
and the chairman of the Republican Senatorial Campaign Committee, Senator
George Allen (R-Va.).
Last year, former FDA chief McClellan, brother of White House press
secretary Scott McClellan, delivered a speech in Mexico in which he
excoriated other countries for regulating drug prices, demanding that
the gap between the high costs of drugs in the US and those of other
countries be bridged by other countries raising their own drug prices.
“The heavy hand of big pharma is felt at all levels of government.
Nothing demonstrates that influence more plainly than the prescription drug
Benefit added to Medicare in late 2003,” writes Angell in The Truth About the
Drug Companies. (p. 193) Described by both authors as a gargantuan bonanza
For PhRMA, the Medicare “reform” is dealt with in more detail by Abramson.
He notes that not only will the drug plan cost seniors more money (an
Average Medicare recipient who spent $2,318 out-of-pocket for prescription
drugs in 2003 will spend $2,911 in 2007), but the bill also specifically
prohibits the federal government from negotiating prices with drug manufacturers.
PhRMA also helped defeat an amendment that would have funded research
To determine which drugs actually provide safe and effective treatment—a
worthwhile endeavor considering that 3 of the top 15 drugs most
frequently prescribed for American seniors in 2003 were Celebrex, Vioxx and
Fosamax!
Solutions
While "The Truth About the Drug Companies" and "Overdosed America" have
their independent areas of focus, there is much overlapping material.
The contamination of science and the scientific process is a theme
Seriously addressed by both Angell and Abramson. Unfortunately, their works
Confirm that an in-depth analysis does not automatically lead to adequate
conclusions.
Angell’s book ends with a whimper not a bang as she promotes the notion
That “most of the changes could be achieved with simple congressional
legislation.” Although she does mention that the pharmaceutical
industry should be “regarded much as a public utility,” demanding that its books
be opened, her basic advice is to strengthen the FDA; require that new
drugs be compared not just with placebos but with older drugs for the same
ailments; curb monopoly marketing rights; and prohibit direct-to-consumer
advertising. As is often the case these days with many such powerful exposés, the
ensuing recommendations appear as an impotent wish list attached to the faint
hope that the powers-that-be can be persuaded to take the moral high ground
and eliminate their anti-social excesses.
On a somewhat different note, Abramson correctly states that the
failure of the market to serve American’s medical needs is not a “market failure,
but a market success.” He adds: “Drug companies earn higher profits when more
people use expensive drugs, not when people achieve better health. Doctors
and hospitals are paid more for doing more, largely without regard for
evidence of improved health outcomes.... Health care providers that deliver
high quality, efficient care are financially penalized for not delivering a
higher volume of more intensive services, beneficial or not (referred
to as the ‘perverse incentive’).” He goes to on to say that “American
politics, science, and health care has created an imbalance between corporate
goals and public interest that is no longer self-correcting. In, fact, it was
become resistant to correction”. (pp. 254-256).
An advocate of universal health care, Abramson pushes for his version
Of reforming the system. He believes that extending coverage to the
Uninsured would trigger a demand for accountability from industry and government,
thereby resurrecting the medical watchdogs. If Americans would stop thinking
that universal health care is “un-American,” then commerce and the state
would fall into line.
In fact, extricating medical science from the clutches of the conglomerates
is bound up with a far greater social transformation, which requires
changes in the foundations of the present system. The present disastrous state
of health care in America is the logical outcome of a medical system
entirely subordinated to profit, with no attention on health. Protest and public
awareness will not halt the process, nor will futile appeals to a bought-and-sold Congress.
Despite their limitations, "The Truth About the Drug Companies" and
"Overdosed America" draw a disturbing picture of the inhuman character
Of production-for-profit in the medical sphere. The books are an important
contribution to exposing the utter incompatibility of the present state of
affairs with the health and welfare of the population.