Pharma: The New Drug Lord?

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Every day Americans are subjected to a barrage of advertising by the pharmaceutical industry. Mixed in with the pitches for a particular drug — usually featuring beautiful people enjoying themselves in the great outdoors — is a more general message. Boiled down to its essentials, it is this: ‘Yes, prescription drugs are expensive, but that shows how valuable they are. Besides, our research and development costs are enormous, and we need to cover them somehow. As ‘research-based’ companies, we turn out a steady stream of innovative medicines that lengthen life, enhance its quality, and avert more expensive medical care. You are the beneficiaries of this ongoing achievement of the American free enterprise system, so be grateful, quit whining, and pay up.’ More prosaically, what the industry is saying is that you get what you pay for.

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself. (Most of its marketing efforts are focused on influencing doctors, since they must write the prescriptions.)

Marcia Angell, The Truth About Drug Companies, The New York Review of Books, July 15, 2004.

photo of drugs

Under the Influence

[pixxietails / Flickr]

When Dr. Marcia Angell — former editor of The New England Journal of Medicine — published The Truth About Drug Companies, it was proclaimed as The Jungle of the 21st century. But whatever shockwaves Angell’s book sent, they clearly weren’t strong enough to unsettle Big Pharma’s foundation.

This week alone The New York Times ran three articles that surely had Big Pharma refilling its prescription for damage control. According to the Times, doctors are reaping millions of dollars by over-prescribing Epo to the detriment of their cancer patients, psychiatrists are raking it in by over-prescribing anti-psychotics to children, and Purdue Pharma is facing hundreds of millions in fines for “misbranding” the painkiller Oxycontin. And these issues are just symptoms of the plague that has overtaken our healthcare system.

We haven’t decided what angle to take for this show. We could build an hour on drug regulation, the drug approval process, the pharmaceutical industry’s relationship with doctors, or as listener duplicity suggested: how patients are trying to circumvent the conventional drug industry altogether. Which of the above shows do you want to hear? Should this be a series? What are your experiences with pharmaceuticals?

Update, 6/11 11:18 pm

We’ve decided — in large part because of your comments — to do a series on the pharmaceutical industry. We’re kicking this off tonight with a conversation with Dr. Marcia Angell. She’ll discuss how the industry has deteriorated since she published The Truth About Drug Companies, and what reforms need to be made.

Marcia Angell, M.D.

Senior Lecturer, Department of Social Medicine, Harvard Medical School

Former Editor-in-Chief, New England Journal of Medicine

Extra Credit Reading

Marcia Angell, The Truth About the Drug Companies, The New York Review of Books, July 15, 2004: “Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.”

Rich Thomaselli, Big Pharma Doesn’t Like How It Looks on YouTube, Advertising Age, June 4, 2007: “The online-video site famous for exploding Diet Coke bottles is blasting Big Pharma as YouTube gains popularity among drug-industry critics as a means to influence public opinion on the industry.”

Christopher Lee, Doctors, Legislators Resist Drugmakers’ Prying Eyes, The Washington Post, May 22, 2007: “Many doctors object to drugmakers’ common practice of contracting with data-mining companies to track exactly which medicines physicians prescribe and in what quantities — information marketers and salespeople use to fine-tune their efforts.”

Peter Rost, Why did Pfizer hire detectives to spy on former PFE executive?, Question Authority with Dr. Peter Rost, June 6, 2007: “Of course, for a big corporation to send out hired goons to monitor shareholders and former executives almost resembles mafia activity, or how Russia sends agents to kill dissidents. And while it may appear surprising for a large corporation to send out detectives to dig up dirt, I think that is exactly how Pfizer operates.”

John Mack, SiCKO is Boffo but Not Anti-Pharmaco, per se, Pharma Marketing Blog, June 8, 2007: “But, as promised, SiCKO is not about Moore confronting CEOs and other corporate bigwigs as he does in his other movies. Pharma had feared this would happen when SiCKO was just a gleam in Moore’s eye: Ken Johnson, senior vice president of the Pharmaceutical Researchers & Manufacturers of America (PhRMA) trade group told a journalist that industry executives were ‘freaking out and pulling their hair out.’”

IgniteBlogger, Public trust eroding, IgniteBLOG: The Perfect Storm, March 28, 2007: “Significant differences between the public’s view of pharmaceutical companies and the industry’s self-perception have caused the pharmaceutical industry to lose the trust of patients, physicians, and others.”

Judy Norsigian, Feeling Great? There’s a Drug for That: How the Pharmaceutical Industry is Selling Prevention, Women’s Voices for Change, May 29, 2007: “The pharmaceutical industry spent much of its $4.2 billion direct-to-consumer advertising budget in 2005 on ads targeting healthy upper-income, middle-aged people. A common underlying message was this: You appear to be healthy, but a deadly heart attack, hip fracture, or other medical catastrophe could occur at any time.”

Ask your doctor about Havidol.


Comments

69 thoughts on “Pharma: The New Drug Lord?

  1. Oh please, expose these evil doers!

    I keep hearing an ad on the radio in my car. It starts out…(I’m paraphrasing but not exagerating) “when your alarm goes off in the morning do you feel like you just went to bed, havn’t had any sleep and dread dragging yourself out of bed to face the same anxiety producing day you faced yesterday”… then it goes on to pitch an anti depression drug. I’m in my car I’m answering the radio “Quit your job!” which to me seems like the obvious to cure for repetitive early morning dread. But noooo, the evil ones want you to keep your awful job and become a good worker/consumer zombie. They don’t want you to feel the pain of a meaningless life. You might do something about it. No, they want your wits dulled so you will remain an obediant drone, a good slave to corporate capitalism, addicted to the chains that bind you.

  2. Questions I would have on this subject would focus on the doctors. So there are instances of direct pharmaceutical company involvment in what doctors are prescribing their patients. But then why all the advertising? The advertising is directed at the consumer, is it not? They if all it takes for a doctor to prescribe a certain drug is for the patient to ask if “Cialis is right for them”, then don’t we have bigger problems then just the pharmaceutical industry?

    I don’t know if we’re talking about payola or just plain laziness but it seems like something is off the mark here. Does anyone else think so?

  3. It’s too bad people are so badly educated…. It is so easy to get detailed and accurate information about medical issues and drugs online (though it sometimes requires a glossary and some web-surfing to gather enough background to understand the data…). The basic problem is that people simply don’t understand everything in life involves risk/reward calculations (including drugs), and that all marketeers have an agenda which may not fit one’s own interests. In other words, one must become an informed consumer. Instead, people seem to want a ‘father figure’ (sometimes a doctor, sometimes the government, and sometimes a pharmacist) to take over their decision making and give them ‘a simple answer’. Alas, we live in a world where many answers are not simple, and where we all need to occassionally ‘throw the dice’ and hope that all of our efforts to make a wise decision will bear good fruit. There’s no ‘magic’ to this. A lot of life, including choices about what (if any) drug to take is simply calculated risk-taking.

  4. There are several key bloggers in this arena. PharmaGossip in the UK: http://pharmagossip.blogspot.com/ And the drug marketing blog from the magazine BrandWeek.

    Here are a few nice recent posts by that guy:

    http://www.brandweeknrx.com/2007/04/its_already_a_b.html

    http://www.brandweeknrx.com/2007/04/at_az_a_potenti.html

    You’ll see he mentions Peter Rost a lot. http://peterrost.blogspot.com/. Former VP Marketing for Pfizer, became a whistleblower, and is now a de facto clearing house for Big Pharma scandals. In fact, in the last six weeks, he’s sparked and fanned the flames on two different scandals, and, according to his blog right now, he’s got another Pfizer employee in the middle of disclosing more information to him…

    So, to me something that’s really notable right now is that insiders have reached the boiling point level of the average educated consumer. Every month some new employee or set of employees is leaking documents…

    • This post is just wrong. You CAN’T get the truth by going online or reading the Physicians Desk Reference or the DSM-IV, or even medical journals. The drug companies spend over $60 billion per year on promotion and only $40 billion on research; but much of the “research” is actually promotion – drug trials designed, controlled and owned by a particular company, comparing their own drug to a competitor drug, with the purpose of showing that their drug beats the competitor. If the results don’t come out right, they just don’t publish the study. But 90% of the time the studies do favor the company paying for the study.

      But that’s just part of it. The companies fund, design and control the conduct of 80% of the drug studies done in the US. If studies don’t produce the “right” results, the companies, who own the information, don’t release the studies, or just release favorable parts of studies. They hire marketing companies to ghost write many – if not most – journal articles, then pay medical “opinion leaders” to sign on as authors. If they do get a positive study, they have ghost writers produce multiple articles based on the same study, so it appears that lots of research supports their drug.

      Consumers can’t rely on the cruel joke of FDA drug approval, either. David Kessler, former head of the FDA, has publicly confirmed how bad the process is: to get a drug approved, all a company has to do is submit two controlled drug trials that show the drug has a statistically significant (not clinically significant) advantage over placebo. The company can (and often does) run many trials that show placebo equal to or better than the drug – that doesn’t matter as long as they get two that favor the drug. And drug trials usually last only 6 weeks, so we won’t know for years what all the adverse effects are (Kessler and others estimate that only 1 in 100 cases of adverse drug effects are actually reported to the FDA).

      Case in point: Irving Kirsch, a bona fide academic, published in 2010 a meta-analysis of all antidepressant drug trials submitted to the FDA for approval of SSRI’s (he had to file a Freedom of Information Act request to get these). He found that about 1/2 of those trials did NOT show a statistically significant advantage for the drugs over placebo, and the average advantage, while statistically significant, was clinically meaningless. He concluded the drugs had no advantage in mild, moderate or severe depression, but showed a slight statistical (but not clinical) edge with very severe depression. A Duke Univ. review of the same information, publisihed in the January 2011 issue of JAMA, confirmed Kirsch’s conclusion.

      This de-pantising of Pharma and bio-psychiatry is in stark contrast to the 20 years of rosy propaganda that emanated from Pharma’s and psychiatry’s noise machine: “Listening to Prozac,” consensus claims in medical journals, news articles, Physicians’ Desk Reference, drug reps’ sales pitches to doctors (most docs’ primary source of information on drugs), and Pharma-funded continuing medical education presentations to doctors.

      Yet the very first trial Eli Lilly ever ran on Prozac showed no drug effect and shocking adverse effects – suicidality, agitation, etc. They kept at it ’til they got the two studies they needed for FDA approval; then they cranked up the PR, and off they went. Whistle blowers like Peter Breggin were scoffed at, ’til nearly 20 years later, the evidence was so overwhelming (even from Pharma’s thumb-on-the-scale drug trials) that the FDA issued a “black box warning” on all SSRI’s that they can cause suicidality in children, adolescents and young adults.

      That’s some progress, but you know what? Despite the warning, and despite Kirsch’s and Duke University’s exposing the relative ineffectiveness of SSRI’s, PSYCHIATRISTS AND PRIMARY CARE DOCTORS STILL PRESCRIBE MASSIVE AMOUNTS OF SSRI’S (10% OF AMERICAN WOMEN ARE ON THEM) AND SALES ARE STILL IN THE BILLIONS. That’s what a $60 billion promotional budget will do for you.

      Oh, and by the way – over 40% of the FDA’s budget for drug testing and approval COMES FROM THE DRUG COMPANIES THEMSELVES. Conflict of interest?

  5. One pill makes you larger, and one pill makes you small,

    And the ones that Mother gives you don’t do anything at all.

    Go ask Pharma, make your Prozac call.

    And if you go chasing habbits, and you know you’re going to fall,

    Tell ‘em a cigar-smoking Pfizer-man has sold you them all.

    Go ask Pharma, make that Prozac call.

    When the men in the boardroom get up and tell you what to know,

    And you’ve just had some kind of soother, and your mind is moving slow,

    Go ask Pharma. Just give them your dough.

    When logic and proportion have fallen sloppy dead,

    And Merck’s white knight is talking billions, and Wyeth red queen’s laughing off her head,

    Remember what the drug ads said: “pop two before bed! …two before bed!”

  6. I’m interested in the pharma industry’s latest move to change the wording in FDA regulations that would make it illegal for an non-medical healing practitioner to recommend food or herbs for health benefits. I guess I missed the hew and cry of the masses about all those deaths and illnesses resulting from the use of herbs and healthful foods. There are however millions of people who have petitioned their legislators to protect their rights in respect to access to dietary supplements, herbs, healthful foods and counselling for the same. The responses from the Senate have been condescending, such as, “callers are not informed about this matter.” (Sen Enzi)

    Right now the Senate and House are processing S. 1082, the FDA Revitalization Act of 2007, in the Senate. It’s an attempt to revamp the development and regulatory process for medications. It is funded by the pharmaceutical industry via some foundation that they will all pay membership fees to. Then this FDA Foundation will direct and faciliate research and regulations. It makes the FDA a partner with the pharmaceutical industry. It looks like it has already passed in the Senate, even though it has a lot of credibility issues. People are trying to get an amendment placed on it in the House to protect food products from this regulatory process. Foods and dietary supplements already have a regulatory process that protects users while allowing them free access. The language in this new bill is ambiguous enough that once it is enacted, lawyers for the pharma industry or this new foundation could argue that they be given control over food products, as well.

    It all seems like a big push to force us to use pharmaceuticals to address any health concerns we have, rather than turning to healthful foods and herbs when we can.

    Legislators that I know are interested in this: Congressman Ron Paul, Congressman Dan Burton, Congressman Peter De Fazio, Congressman Chris Cannon, Congressman Frank Pallone

  7. tbrucia,

    Its is difficult to educate yourself about everything. And unless you are a good researcher, you can’t know how to use the internet for meaningful information. I know several librarians who just roll their eyes at what people claim they have learned on the internet.

    We don’t all seek “father figures” per se. In the complex world, as you define it, the complexities are too much for one person to become enough of an expert in everything to make educated choices. This is why we have experts and we rely on their expert opinions to some extent. I am not a mechanic, so I have to trust the mechanic when she says that I need to repair my front axle. I shouldn’t have to be concerned that her parts supplier is threatening to withhold all parts if she doesn’t sell enough axles. Or that she will get huge benefits if she sells enough axles. (I know the analogy may be mechanically unsound, but you get the point..)

    It is not simpy a matter of self-educating and accepting risks. We have a right to expect that the people who are highly trained in a field that can mean life or death, are acting in our best interests. It is actually an important aspect of making educated to choices to choose to fight for correction when you learn that the system is not serving us well. The pharmaceutical industry needs a smackdown and we need to let our authorities know that we’re ready to make that happen. We’re all paying a huge price for the way these industries behave.

  8. Thank you Allison for your informative post. I did not realize the Phama Corporations were still trying to “protect” us against healthy food and herbs. (I remember this same issue being big 15-20 years ago). The Phama Corporations also want very much to protect us from getting cheaper perscription drugs in Canada on the grounds that Canadian drugs (for the exact same perscriptions) may not be “safe” enough for Americans. Certainly, they are not expensive enough.

    I’d like to know just how rich these Pharma CEOs are.

  9. i think the Pharma debates can easily be a series. Enough opinions and hands in pockets to go around.

    The medical profession needs its own rebooting of pharmaceutical relations, like government did with lobbying. We should be asking the doctors to police themselves a bit more. Pay to play in clubs rips off bands who have no money. Pay to play on the radio is payola with disc jokeys and labels in collusion. Very hypothetically: Can you imagine the equivalent of drug marketing and distribution following today’s floundering music model…? A total lack of faith in the industry on the customer side, so manufacturers go independent and consumers adopt a deregulated product bought directly from the manufacturer… Intriguing and kind of horrifying.

    —-

    From what I understand, which is little, Pharma’s patent life is very short due to so much time spent in R&D. By the time a workable beta makes it to FDA testing, there isn’t much time left before the patent dies. The FDA is so bogged down with new products that drugs sit in a cue forever to be analyzed. Pharma has many ways to cut in line then rush clinical testing and public release before the patent runs out. Then, maybe, for one year a new drug is the only one available before copy cat formulas in different colored packaging come out. That’s why there is so huge a push and marketing blitz (to doctors, to medical conventions, to TV) early on, to make as much as possible while Pill X is the only one on the market. That way, it becomes the Kleenex of the medication world (not nasal tissue). There’s some proper brand-ese term for this and its the reason they advertise to everyone, not just doctors. We only have one common term for Viagra, and every competitor starts at such a disadvantage when they unveil their own erectile enabling pill or whatever the real name is. Coke is to cola what Viagra is to _____.

    One fix would be to extend patent-life, eliminating the rush to be first and allow better quality control pre-release. Companies wouldn’t try to make every kind of pill, but perfect a few. The FDA would have less competing drugs to test, freeing time for other products or herbs and such. But that’s unlikely. Changing intellectual property laws is such an uphill battle and kind of unfair to the consumer because the sole owner of Pill X will keep the price high while it’s the only game in town? Or not, my economics is/are pretty weak.

  10. One of my occasional jobs to is do administrative work for an american-exchange program here in amsterdam. I get to meet each student as they arrive from the US and frequently I see their medical records when it comes to what pers. drugs they take. 9 out of 10 exchange students are on something related to trauma, anxiety, disorders of all kinds… it is amazingly sad.. is it really true that 9 out of 10 college kids NEED to be tethered to these terrible drugs for probably the rest of their lives? I think its the companies that have created this “need” and there’s the trillion dollar industry to re-enforce it.

  11. ///We have a right to expect that the people who are highly trained in a field that can mean life or death, are acting in our best interests. /// The lesson of life is that one must look out for oneself. (Love many, trust few). One can EXPECT a lot of things, but only knowledge can assure us that others are acting in our best interests. And expecting loyal members of any profession (including government bureaucrats and politicians) to protect anyone other than members of that class is simply naive. As a wise man once told me, ‘Don’t ask a nurse if a doctor is a good doctor; just ask her who is HER doctor!’

  12. tbrucia, I’m not saying that we should be blind or stupid. I am saying that we can DEMAND better. I can’t be expected to understand medicine. I didn’t go to med school. I must be able to rely on practitioners to some extent. Yes, choose wisely. Shop around, etc. And, DEMAND, that our docs and our regulators get out of bed with the Pharma industry. It’s not acceptable. As consumers, we have the right to fight for that. And to highlight and discuss any indiscretions about which we know.

    Being someone who suffers some serious health issues after a lifetime of good exercise – was a competitive athlete through my 20s and very fit until I gave birth – and healthy eating – been eating organic for at least 15 years – I know the drill of looking out for youself when it comes to medical care. I’ve been through a lot and have dumped docs along the way. It doesn’t remove our communal responsibility to demand and get systems in place to best ensure, that our medical practitioners are not putting our health first.

    When you dig into the topic, it starts to take you down that path of asking, “When does our economic system measure more than the dollar?” Is it a good economic system if Pharma-profits are deemed good when their methods are detrimental to the health of so many? When do we question the religion of the market economy?

    By the way, tbrucia, I feel sadness when I read, “The lesson of life is that one must look out for oneself.” Is that THE lesson? And knowledge is only a step. Action has to follow. You set the expectations and you demand that they be met. It’s a pretty basic plan for keeping life moving along well.

  13. It’s too bad people are so badly educated…. It is so easy to get detailed and accurate information about medical issues and drugs online (though it sometimes requires a glossary and some web-surfing to gather enough background to understand the data…). The basic problem is that people simply don’t understand everything in life involves risk/reward calculations (including drugs), and that all marketeers have an agenda which may not fit one’s own interests. In other words, one must become an informed consumer. Instead, people seem to want a ‘father figure’ (sometimes a doctor, sometimes the government, and sometimes a pharmacist) to take over their decision making and give them ‘a simple answer’. Alas, we live in a world where many answers are not simple, and where we all need to occassionally ‘throw the dice’ and hope that all of our efforts to make a wise decision will bear good fruit. There’s no ‘magic’ to this. A lot of life, including choices about what (if any) drug to take is simply calculated risk-taking.

    What thrucia said.

    Doctors are only human and are subject to the same prejudices, ignorances, emotions, and laziness as anyone else. Recently a surgeon proposed to perform a type of hernia surgery on me that might potentially have been very dangerous for someone with my medical history (which the surgeon was apprised of). I discovered the risk by reading the professional (peer-reviewed) literature and a second opinion with a different specialist confirmed that that surgical method would have been a very bad idea for me, so of course I cancelled it.

    I never fill a prescription without researching it fully, again, in the professional literature.

    I’m sorry but, as in so many other things in life, no one is going to look out for you. Whether we’re talking about healthcare decisions, retirement planning, insurance and mortgages, or taking positions on public policy like invading foreign countries, reforming social security or fighting climate change, the same advice applies here as when we were in school: Turn off the damn TV, crack a few books, do your homework!

  14. Foods and dietary supplements already have a regulatory process that protects users while allowing them free access.

    Dream on. Visit any CVS and take a walk down the aisle where they sell “dietary supplements” and “herbal remedies” and “hoemopathic” medicine. No one is protecting consumers from the wild claims made on some of these packages. There is a very low science/hype ratio behind most of that stuff.

    IMO herbal and homeopathic claims should be subject to the same approval process and demonstrations of safety and efficacy as Big Pharma drugs. Currently all they are subject to is purity regulations – if I sell a capsule advertised as 100% pure gulliberry then it has to be 100% gulliberry. But if I want to suggest that gulliberry helps you to sleep, improves digestion, relieves the sniffles, and gives you a cheerier disposition I don’t have to prove it.

  15. I think its the companies that have created this “need” and there’s the trillion dollar industry to re-enforce it.

    Why blame the companies?

    Why not blame the kids themselves for getting the idea in their heads that they should never suffer anxiety, sadness or insomnia? Americans think that the normal emotional experience of LIVING is a medical problem that needs treatment.

    And while we’re at it, what about the parents? First they let their kids watch TV for 7 hours a day frying their little brains and giving them the attention spans of Roomba; they they demand Ritalin because their crazy kids are making THEM crazy.

  16. I can’t be expected to understand medicine. I didn’t go to med school.

    I didn’t either but I’m a smart person and I can read and study. I’ve seen doctors make all kinds of errors in judgement for me or loved ones. Usually it’s because they were rushed or didn’t take enough things into account or weren’t up on the latest research, or sometimes they just forgot something. But I haven’t seen one yet that I could attribute to big-Pharma pressure. So my point is that getting doctors out of bed with Big Pharma is not going to relieve people of the need to do their homework.

    and healthy eating – been eating organic for at least 15 years

    I’m an organic gardener because I think that it’s better for the environment, but there’s no scientific evidence eating organic food is any healthier at the individual level.

  17. I’d like to hear Dr. Angell talk about the Birch-Dole Act of 1980. I know that in her New York Review of Books articles she described the effects of this legislation. As I understand it, once upon a time, the government funded research, and then the government owned that research. Since 1980, however, the government has been paying for research while allowing universities and private companies to own that research–and get rich off of it. And so American consumers aren’t just paying for their prescriptions, they’re also paying for the R&D for these drugs as taxpayers. Furthermore, they’re not even getting better more innovative drugs; Dr. Angell has also pointed out that what we get now are copycat drugs, not many new, innovative products.

    Check out this article: http://money.cnn.com/magazines/fortune/fortune_archive/2005/09/19/8272884/index.htm.

    The listener discussion above about whether or not ordinary people can be expected to understand medical information reminds me of a point I’ve heard Dr. John Abramson (author of _The Overdosed American_) make in interviews: that is, the drug companies are so skilled getting half-truths published in prestigious medical journals, that it’s really hard for family doctors to get reliable information. If my family doctor is being tricked by a clever ruse in a medical journal, I don’t see how I can be expected to be any smarter.

    So many people these days reject conventional medicine for something they call “alternative medicine” because they understand that we really do need an alternative to the current system of health care. And I’m sympathetic to the idea that other cultures may have excellent systems of traditional medicine that we can learn from. But rejecting modern medicine for (often) untested and unregulated therapies always seems to me a bit like rejecting the theory of evolution. We don’t need to reject the ideals of traditional medicine–rather, we should be defending them from the pharmaceuticals and the insurance companies. Drug companies’ misbehavior, it seems to me, is giving science itself a bad name.

  18. It seems to me that investors, who demand ever higher earnings, quarter after quarter, put incredible pressure on managements. ‘Give us more money, or we will dump you and your company’s stock!’ Managers who have spent decades clawing their way up the corporate pyramid realize that a couple of bad quarters could spell the end of their careers… as they are replaced by folks eager to make more (unrealizable?) promises to the investing public. —- Also, the pricing issue for drugs goes undiscussed in any analytical way. The problem is that if a pharmaceutical firm prices the same in every nation it will sell ZERO

  19. … (ooops)… ZERO drugs in very poor nations, and will forego sales in wealthy nations. On the other hand if it allows cross-subsidies, where it charges the wealthy (e.g. Americans) more, and the poor (e.g. Costa Ricans) less, the drug industry is accused (with some reason) of discriminating against American consumers. The underlying issue (never mentioned) is the radically unequal distribution of income/wealth in the international community. No one gets upset about the sales of VCRs or motorcycles or cameras and the fact that they are priced differently in different stores or in different nations — but when it comes to drugs (which often involve issues of life and death) more primal areas of human emotions come bubbling up. And they should… but a bit more rational thought and a lot less invective wouldn’t hurt the discussion, either. —- I won’t even get into those whose reply to modern medicine is to go back to the voodoo doctors and their ‘alternative medicine’ strategies. If Americans want ‘alternative medicine’ they can find plenty of it in Haiti, among Hispanic ‘curanderos’, or in sub-Saharan Africa. A simple comparison of European levels of disease (not to mention longevity) versus Third World levels should demonstrate to those thinking with their heads (rather than other organs) that the alternative to modern medicine may prove ‘unfortunate’.

  20. A final thought: Companies are legal fictions (granfalloons) and companies don’t ‘get rich’. Firms are simply pipelines connecting investors to consumers, and there is fierce competition among INDIVIDUALS for control over the pipelines. INDIVIDUALS working for companies can be greedy, but the corporation is simply a legal machine, as unconscious and as incapable of greed as an electric toaster.

  21. Big drug companies are really nothing more than modern day hippies on steroids. What was it Timothy Leary said ”Turn on Tune In, Drop out,”

    This is all just another bi- product of the 60′s generation. It’s true destructive nature is just now fully coming to fruition.

  22. I think that this topic is related to the recent ROS show about Rupert Murdoch and the Wall Street Journal. Both topics raise the question of whether the public is harmed when certain types of businesses (newspapers, drug companies) become nothing more than cash machines for CEOs and investors. Drug companies do need to make money, and the prospect of making money does, in theory at least, encourage invention. But the single-minded desire to make money leads to the horrors described by Dr. Angell in her New York Review of Books review of the film “The Constant Gardener.”: http://www.ahrp.org/infomail/05/09/19.php. In short, Pfizer tested a new drug on children in Nigeria during a meningitis epidemic. As the article points out, the research violated every standard of American human subjects research–which is precisely why it was done in the Third World.

    My question is, how well is laissez-faire capitalism really working from the point of view of the consumer of pharmaceuticals? We were told that Bayh-Dole was going to lead to a paradise of untrammeled invention and creativity, which would lead to a host of fabulous new drugs. We haven’t had that–instead what we get are clones of drugs already on the market. Furthermore, we have drug companies that are evading the regulations so carefully set up in this country, and using Africans as their guinea pigs instead.

    I was a child in the 70s and I remember all the talk of the “failure” of liberalism; high crime rates in cities and so-called welfare queens were presented by the likes of Ronald Reagan as the evidence that liberalism didn’t work. Now nearly 30 years into the Reagan revolution, we see conservatism imploding, what with laissez-faire capitalism actually discouraging the invention of better drugs, with small cities and towns in America plagued with rampant gun crime due to the absence of gun regulation, with rates of infant mortality going up in places like Mississippi. (You mean that brutally cutting services to the poor does not magically render them able to pull themselves up by their own bootstraps?) Not to mention the fact that the global transportation of food squanders precious environmental resources, while agribusiness keeps tricking American consumers into thinking that we’re getting cheap apples from New Zealand, when in fact we’re being charged through the nose for them via high gas prices, high taxes (to pay for costly Middle Eastern wars), and the costs associated with global warming.

    Now all of that taken together (i.e. the Reagan revolution at age 30) is the subject of an entirely different show, but I do think that dysfunctional pharmaceutical industry needs to be thought of as one piece of this particular puzzle.

  23. As much as I find myself biting my tongue as I say this, I think it is unfair to place the greatest blame on Pharma companies. After all, they are operating within the system that exists, and it is foolish to hold them to a higher standard than anybody else. Are they often greedy and corrupt? Sure. But why should we expect them to uphold some higher moral law if there is no indication that we demand it? When I was eight, I would eat chocolate chip cookies to the point of illness if my mother was away, and I only stopped when I realized that there was oversight (my mother’s careful monitoring of the Chips Ahoy stash) and consequences (my father’s wrath).

    Yes, this is an oversimplified answer. But the truth is as long as the entire system of regulation and oversight is treated as a joke, why should they change? The FDA has been exposed time and again as toothless and spineless at best, and corrupt at worst. So where is the indignation from the public? Instead of crying about the “evil companies” why not insist that government do the job we have assigned, rather than the corporate bidding that we have allowed them to do?

  24. I’d like to see ROS focus on DTC (direct to consumer) advertising of prescription drugs, the allowing of which I think has been a horrible mistake by almost any reasonable measure.

    See “What Are the Public Health Effects of Direct-to-Consumer Drug Advertising?” in PLoS (Public Library of Science) Medicine: “Almost all government, health professional, and consumer inquiries into DTCA have concluded that it causes net public harm. It is too difficult to regulate DTCA, so I believe that the logical conclusion from the evidence is that the best option for improving overall health and wealth is to ban all types of DTCA, including “disease awareness” advertising. Drug company Web sites and media releases should be regulated carefully.”

    See also “Direct to consumer advertising” editorial in BJM (British Medical Journal) at http://www.bmj.com/cgi/content/full/330/7481/5, which concludes: “The public is ill served when governments allow promotion of prescription drugs that stretches the limits of the law—and beyond. No country has been successful at regulating any type of direct to consumer advertising to ensure the public obtains reliable balanced information on drug benefits and risks. Repeated breaches by companies speak for themselves. The potential awareness raising benefits of direct to consumer advertising could be better targeted and sustained at lower cost with less harm through publicly funded and accountable drug information services and health campaigns.”

    Good material also at http://www.newstarget.com/drug_advertising.html, including “Doctors group calls for limits on drug advertising” and “The great direct-to-consumer prescription drug advertising con: how patients and doctors alike are easily influenced to demand dangerous drugs”

  25. (plnelson wrote) ..”I’m an organic gardener because I think that it’s better for the environment, but there’s no scientific evidence eating organic food is any healthier at the individual level..”-

    Should I assume that you’re part of “the environment”? hmmm… There’s actually very good evidence of research, with fruits & grains, that following the prophylactic spraying programs as recommended for “conventional” food crops, while providing a somewhat larger harvest, can’t come close to providing as nutritious a product as a crop which is allowed to be attacked & stressed a bit by “plant pests” (other than ourselves). It seems to indicate that those substances we value as “vitamins”, antioxidants, etc are produced in greater volume because they are part of a plant’s antibody- equivalent response to harm. This might also help to explain why wildcrafted medicinals, growing in soils a bit less rich than the “farm & garden” variety, may have greater potency. (I can’t quote the studies directly… they were from UC Davis about 4 or 5 years ago… and the first tests were strawberries & corn.)

    (from tbrucia) ..”A simple comparison of European levels of disease (not to mention longevity) versus Third World levels should demonstrate to those thinking with their heads (rather than other organs) that the alternative to modern medicine may prove ‘unfortunate’..”-

    Say, how about alternatives to ’3rd-world government’? I don’t know how “1st world” the Colombian Andes may be, or where Bulgaria fits in to the EU spectrum, but both places have a higher number of active & healthy centenarians as a percentage of population than any other places- incl USA & “Old Europe”… ^..^

  26. Peggysue: You need to remember that not everyone can just get up and quit their job. Not quite that easy.

    Thrucia: Thank you for your initial post. Very important to remember that we are the end user of these items, and it’s up to us to determine what we want to put in our body. While I’m certainly not defeding stupid ads like the one that Peggysue mentioned, (yes I have those feelings…..I”m ALIVE after all…), the impetus lies with us and a doctor that we trust (there are lots of them out there that are good…..although I certainly understand that it’s more difficult in the US than here in CAnada…).

    Let’s take a quick minute to remember that these companies do occasionally create good things w/ their R&D and their money. If it weren’t for a company called Novartis greating a drug called “gleevec” I probably wouldn’t be alive.

    Again, not defending, just reminding that we need to look at our blind consumerism.

  27. John Navas: thanks for the posts, but your (or the doctors’) push to limit/halt direct to consumer advertising based on misinformation seems so muddy. That line of thinking lends itself to monitoring or censoring everything else which is bad for you. Stop fast food advertising like cigarettes? Big Macs are far worse for our health en masse. Then what’s after that… milk isn’t good for you after a certain age, then chairs without proper back support…

    From the PLoS Medicine: “the best option for improving overall health and wealth is to ban all types of DTCA, including “disease awareness” advertising. Drug company Web sites and media releases should be regulated carefully.”

    The ammount of monitoring, fines, court hearings, petitioning, and red tape would take too much man power and waste so much time. Who would shoulder that work? The government? The networks and publishers (can you imagine the reporters who would get fired to cover the cost)? That means publishers would have to come up with a unified system or work with varying limitations (even more confusing for the consumer), and it’s not as if fact checking drug ads is as easy as calling a politicans’ office to confirm a statement. To act as a censor like the FCC checking ads after the initial piece of false or faulty advertising aired isn’t productive. The damage would be done to viewers while Pharma and networks battle it out with lawyers. Whoever hears about retractions?

    For devil’s advocate purposes, nearly every ad contains those horrifying “may cause drowsiness, liver hardening, diarrhea, instant death, disease, evil, in pregnant women, the elderly, people taking other medications, and some blondes” which always causes more buyer’s weariness toward the drug rather than boost confidence in or create desire for it. There’s already a system of requirements for the advertising. Fix the FDC clearing bad product first, don’t fight the advertising of a bad product.

  28. type II errors resulting from applying the precautionary principle may cause more harm than type I errors.

    Pharm companies are very scared of commiting type I errors.

    Type IIs are those that occur because a drug/product wasn’t released to the market causing more harm (by its absence) than could have been caused by it’s presence.

    That brings up the topic of pharmacogenetics …

  29. Ten years ago, after I took a combination of drugs prescribed by supposedly reputable doctors, I experienced a number of side-effects that proved to be lasting, and were I not as strong as I am, would have proved to be devastating. One of the first things that happened was a loss of muscle control. Soon I fell repeatedly, suddenly, and with such force that I hit the ground as if I had been in a car accident. I told my primary care physician that it felt as if I were being propelled forward headfirst and she said my blood pressure was dropping precipitously. She kept me on the drug. My mind was so buried on this drug that I didn’t question this. Another doctor mentioned something that caused me to ask her if a particular drug I was on could be causing me to fall and to lose coordination. She said, “Probably.” I said, “Why didn’t you tell me this would happen?” She responded, “Because you wouldn’t have taken it.” When I mentioned that remark to another doctor, her response was, “Cool. She told you the truth.” All the doctors I saw spent a lot of time with pharmaceutical reps and said they had to, because their patients couldn’t afford the drugs.

    I went off those drugs, but even going down by tenths, I had serious withdrawal symptoms which I dealt with for years, and once I was off them, I continued to experience more symptoms. The doctors that prescribed the drugs, one of them at a level probably 24 times more than my body could handle, refused to listen to what happened. I was told that it had nothing to do with the drugs, but must be about menopause, or that I had the flu (for years), or I must be crazy to expect them to believe this, or that I must be crazy and therefore causing the symptoms, or that I was lying. I’ve talked with many women who have had the symptoms, usually while on the drugs, sometimes afterward. I’ve read that millions of people have become sick after stopping the drugs, both here and in the UK. I’ve also read articles in reputatable medical journals (usually not in this country) that discuss the lack of clinical trials employed by pharmaceutical companies. During aborted clinical trials for one of the drugs, they discovered that people became worse after taking their drug. Their solution was to discontinue the trials and get the drug on the market. I saw several doctors, all of them affiliated with Harvard, and pharmaceutical reps were in their waiting rooms at least 50% of the times I was there.

    This morning I fell on my way to work, after experiencing, suddenly, sedation. After years of falling at least once a month, I now slam down to the concrete only once every several months. Earlier this year I fell twice, once tearing a rotator cuff and another time, cracking a rib. Fortunately, I heal quickly. I’m sure I’m just clumsy and this has nothing to do with drugs. I feel lucky, because I’ve talked with two women who were hit by cars while taking the drugs. One of the women suffered a shattered pelvis. Someone had a stroke. Another, a seizure. When I first took one of the drugs, I almost fell off a subway platform, but was yanked back by someone standing nearby.

    Yesterday I talked with a guy who worked at the Department of Public Health. He told me about the role the pharmaceutical companies played in the new law that requires us to buy insurance. He talked about money the state took away from smoking cessation programs and programs that helped poor people manage their diabetes, in favor of insurance that will allow doctors to prescribe more drugs to the same patients without the support and education needed to manage these issues. He said that while at a clinic in Roxbury, he commented on the food catered for one of their meetings. Someone told him that the pharmaceutical companies provide this. The staff person laughed and said, “I don’t know why they do this.” Maybe catered lunches are the extent of what they provide in Roxbury. They provide a lot more “perks” in other neighborhoods.

  30. Sounds like there’s lots of interesting show ideas. Something looking at the ab/use of DCA could be fascinating, and I’d also vote for something on ‘complementary’ treatments (could be interesting to look at a range of approaches, from harmless complementary pills like homeopathic remedies to potentially fatal treatments like chelation therapy). Or how about something on the different ways in which drug companies distort the results of clinical trials?

    Definitely scope for a series :)

  31. I’m grateful to any attention this issue gets. I am a home health occupational therapist working with geriatric patients who return home from the hospital. I am horrified by the mis-management of prescribed medications to vulnerable seniors. At an age when bodies metabolize individually, different than any norms, and at an age when managing new and variable information is difficult, patients often have a list of 10-15 medications, often from different MDs with a poor system of case management. Our home health RN may be called in to follow-up but not always and is available maybe 2x/week. Many times patients lose their appetite simply because they dutifully take all their pills and are full. Now well known is the expediant response of treating side-effects with another medication. Pharmaceuticals as the treatment of choice in todays US system of medicine is regressive and to some extent criminal. This topic warrants a series addressing: heal the healer, profit-based health care, the loss of self-care knowledge, comparative health-care, and more.

    I’ll be listening with gratitude. karen

  32. Thanks to allison for raising the issues regarding herbs and natural remedies. I think it should be pointed out that the term “side effects” is a misnomer–a case of Orwellian language serving an establishment point of view. Drugs do not have side effects; they have “multiple effects.”

    Just how insidious this is is demonstrated by katemcshane’s use of the term (unavoidable in the current culture) in her moving description of her own terrible pharma experience.

  33. With due respect to tbrucia and pinelson, the Ancient Roman slogan “caveat emptor” hardly the consumer standard anyone in our late, great republiic should have to abide six years and counting into the 21st century, or what’s a tax dollar for? Placing the burden entirely on the consumer in line with the typical conservative ploy of reducing an ethical issue to an epistemological one, the culprits playing changes on the fine print no matter the mischief and tragedy that ensues. There’s a clear echo here of positions taken on the recent Katrina show — and the show about insurance — where people lucky to escape with their lives were faulted for losing their homes. Lucky me — so far — I take pharmaceuticals — aspirin — maybe three times a year; stupid me, according to this logic, I never read the fine print. Wish me well the next time around.

  34. On the interview last week, in talking about the kind of existential pain that leads to sleepless hours in the middle of the night, Norman Mailer condemned sleeping pills for “supressing” the problem and (paraphrasing here) “driving it deeper.” A very apt metaphor (or, rather than metaphor, description) for much of pharmacology including antidepressants.

  35. Speaking of existential pain, a young woman at my last job, a student, very shy, extremely talented artist, suddenly became outgoing. It turned out she was taking Paxil, the “social anxiety” drug. She said to me, “It’s great, Kate!! You don’t even have to see a shrink. You can just get it from your primary care doctor.” I told her about some of the problems Paxil causes, but she didn’t want to hear about them. Soon she was so sick every several days that she had to go home. She had severe abdominal pain, and couldn’t eat most foods. This had happened to me. Some of us tried to convince her to stop taking it, but she was so afraid of going back to feeling extremely shy that she was willing to put up with the side-effects. A friend of ours told me about a year later she was having the physical symptoms of panic attacks, but when he urged her to stop the drug, she said, “I can’t.” I saw her last summer — this was one of most talented painters I’ve ever met — and she said, “I haven’t painted in years. I work in an office.” She still takes Paxil, because she is too afraid of how she would feel without it. She doesn’t feel much of anything, from what I saw. She seemed to feel buried by her job and, as a result, her life.

    Almost every student who worked at that same job with us was on either anti-anxiety or anti-depressant drugs.

  36. Just a comment on the guests statement about the free sample of drugs and her comment that they are never for generic drugs – the generics don’t have to prove efficacy, therapeutic drug levels, etc., so it is important to make your listeners/readers aware that a generic is not guarenteed to be the same as they name-brand.

  37. Marsha Angell is great!!! I didn’t know anything about her, so I wasn’t expecting too much. After 10 years of being made to feel insane for my thoughts about this insanity, I feel so relieved to hear her say what I’ve been saying (to myself) for 10 years, things my doctors made me feel horrible for thinking. (My doctor made me feel like I was nuts for believing in herbs, but I was very healthy for 17 years and all I ever took was an aspirin or herbs.) What is so sad to me is that I asked for help because I had a boss who was threatening me with his fists. I kept telling them I wasn’t depressed, and I didn’t need an anti-depressant, didn’t WANT one — I’m usually pretty convincing — I wanted something to help me feel less terrified and I might have taken it for a few weeks (that was my idea), but they insisted that, given my trauma history, I was nuts to suggest that I didn’t need an antidepressant. If you knew the symptoms I try to cope with every day, you’d be appalled — because these drugs effect your brain, which means they change every function in your body.

  38. I write as one who has benefitted from contemporary glaucoma meds for two decades, having thus far avoided surgery. So I acknowledge the contributions of the pharmaceuticals.

    During the 1970s my father worked for a consumer product, over-the-counter concern that was affiliated with a pharmaceutical. He was endlessly frustrated that the scripts people could NEVER accept or acknowledge that business conducted outside of their “bubble” or protected sphere had only maybe half of the profit margin that they operated with. They have only built upon this denial of reality and have actually been supported and facilitated in this by the feds since the Reagan era.

  39. We at iCaduceus.com are attempting to build software to train Clinicians how to think holistically. The basic problem is not just pharmaceuticals but the thought process behind drugs. Doctors attempt to “cure” disease through removal of symptoms. But each person has a different reason for the symptom. Without careful analysis of that symptom one cannot figure out the true disease process. Doctors give drugs as a knee-jerk response to a particular symptom without any analysis. Our goal is to retrain doctors to analyze and then use less harmful substances.

  40. Bear in mind that the biotech industry was well underway before Bayh-Dole, and universities have been patenting publicly funded research, with government approval, since WWI. Bayh-Dole was a “legitimization of long-standing practice. This is increasingly well-documented in the scholarly literature.

    Dr. Angell points out an important point about the backward integration of pharmaceutical companies into universities: universities are, indeed, considered “first phase pharmaceutical companies,” and they increasingly only study what is patentable. Low-incidence diseases or conditions are of little interest–and no wonder: the royalty stack exceeds the cost of goods. We are a “drug culture,” seeking easy outs for the most minor inconveniences, and this has paved the way for a “laughing all the way to the bank” attitude on the part of pharma. As Angell has pointed out, those who are really sick? There’s no money in them.

  41. Firgive me — Marcia Angell is one of the best guests you’ve EVER had!! This is right up there with Sonny Rollins!! You know what a compliment is!

  42. I’m an idiot. I meant to say — Forgive me — Marcia Angell is one of the best guests you’ve EVER had!! This is right up there with Sonny Rollins!! You know what a compliment that is!

    (I have been up since 2:30 a.m., because I’ve been such a wreck about getting a manuscript ready and I couldn’t sleep.)

  43. What boggle my mind is why people do not get more upset over “treatment” instead of “cure” research. I understand from big pharma’s standpoint. I mean, who would make a lightbulb that would work longer than the average lifespan of the person using it? It seems to me that pharma places this limit on their medication in order to guarantee a constant influx of income. But why doesn’t the public get more upset over this fleecing? I personally have sworn off these “treatments”. I have high blood pressure and high cholesterol, but I would rather die a few years sooner than shackle myself to these companies for the rest of my life. I understand that there are people out there who would die if not given teatments for major illnesses, but for something like “erectile dysfunction” seems a little silly to me.

  44. Methinks the lady doth smug too much!

    I’ll take her seriously on the economic issues, but on the practice of medicine she’s not serious herself. She’s a scold and off-base on the actual effects of the drugs. For example, slight changes in SSRIs, for example, make it possible for the “tweaked” drug to help some that the “original” doesn’t touch. The number of variables involved in connecting to neurotransmitters is staggering and the idea that there could be one drug for all is wishful thinking.

    Her charge of “lifestyle” drugs to criticize drugs used for the famous ED is smugness to its height. Of course if you’re a staid new england prim and proper lady and gentleman, sexual intercourse is a shocking necessity, but not something to be desired for cementing the love between a man and a woman. Her casual comment that “impotence,” a term she prefers is episodic and not very important. Her breathless expose is monumentally silly and undermines the seriousness of her critique against Pharma.

    And dear Chris, you’re breathless fawning and credulousness is depressing, in itself. I think I’ll go take a prozac and pray your hard-nosed journalistic senses arise from their sleep.

    By the way, I survive because of one her lifestyle drugs, called Provigil (Modafinal), which keeps me awake without having to rely on amphetimines. I have a lifestyle disease called narcolepsy.

    Chris and Marcia, the human body is not a machine, the oil that works in a Ford should work equally well in a Chevy. But, the drug that works for Jones may not work for Peters, and all the large scale studies she quotes cannot account for that. Only caring observant doctors can.

    The challenge of Big Pharma is real and grim, but stick to the issue and avoid the silly references to “studies” that do not study actual practice of real people.

    Jack

  45. What Marcia Angell just said about the FDA and clinical trials — when the drug company who sold xanax — I forget who it was — their clinical trials showed that it made people WORSE, so they stopped the clinical trials and put it on the market. (I, unfortunately, had what is called a “paradoxical reaction” to it — which means that while my boss was threatening me with his fists, I was feeling even MORE terrified, AND I was being diagnosed as crazy for having that paradoxical reaction.) And I remember doctors talking about prescribing a LOT of xanax to people who were elderly in nursing homes — maybe 6 – 8 times or more of what people felt was reasonable — and they defended it by saying — they’re out of control! When you’re getting older, as I am, and you hear doctors talking like that, it’s very frightening. My feeling is — I’m staying away from them. Also — I love this — people who did well on xanax were willing to go along with WHATEVER their doctors suggested, and thought of doctors as authority figures they would trust with their lives. I remember that my doctor was disgusted because I wasn’t like that. Sometimes, life is — what? INSANE!!!!

  46. . . . . Her casual comment that “impotence,” a term she prefers is episodic and not very important is insensitive, boorish, and wrong. She should be ashamed of herself. She obviously is innocent of the science and psychological meaning of her “impotence.”

  47. Let’s not forget, however, that these “treatments” are generally for the symptoms, not always the source. Wouldn’t our money;(the money that goes to fund the research at government sponsered research facilities) be better spent on finding the root causes of these illnesses, instead of just covering up the problem?

  48. my mother, who is in a state of degenerating dementia, has been taking @12 pills a day for MANY MANY YEARS! i have been screaming at her for all of that time to get some coordinating help on her pharmacuticals (sp?). there is simply no way for anyone or anything to have the faintest idea of the interactions of 12 pills a day. some one with some skill must prioritise the situation. hell, i can’t even remember if i’ve taken my multivitamin.

    there is no doubt in my mind that the cause of her dementia is her pill cocktail. i live far away and have little or no influence over the situation.

  49. huff: “You need to remember that not everyone can just get up and quit their job. Not quite that easy”.

    Please belive me I do know it isn’t easy. Perhaps I was being cavelier but the reason I understand that depression can be caused by jobs is because I’ve had so many really crappy jobs.

    rc21: You are so funny. Have you ever met a hippy? There is a big difference between hippies and Phamcutical Corporations. People who sell pot go to jail. People who sell Prozac get rich.

  50. ///Hurley says: ‘the Ancient Roman slogan “caveat emptor” hardly the consumer standard anyone in our late, great republiic should have to abide six years and counting into the 21st century, or what’s a tax dollar for?/// We don’t live in “a great republic”, and the numbering system of centuries is irrelevant when it comes to human nature. As for what a tax dollar is for, it’s obviously for the political class to disburse to obtain power and wealth for themselves…. Maybe things are different in Italy, but I doubt it. Every person needs to watch out for him or herself and his or her family. Most other people don’t really care…

  51. Marcia might be interested that the Washington Academy of Family Physicians just held its annual scientific assembly last month, and for the first time the entire meeting was completely Pharma-free.

  52. Excellent show, and a great guest — precise, informed, elegantly impassioned: I’m in love. Have her back. My nomination for the next Surgeon General.

    tbrucia: “great republic” an obvious irony, even a thudding one. I hear where you’re coming from, but while unrelenting consumer vigilance might be exemplary — if pretty goddamn tedious — it’s not always possible, and in a better world would be to some extent redundant i.e. in a world where the regulatory agencies, which are paid for by the public to serve the publiic, nominally at least, actually did the job they were created to do. But your skepticism is of course sadly justified.

    Pace Chris’ remark, I just tore my rotator cuff, and boy does it hurt. Staying clear of the pharma, though; glad to hear the exercise route paid off.

  53. I believe KmcS said this above: “I saw several doctors, all of them affiliated with Harvard, and pharmaceutical reps were in their waiting rooms at least 50% of the times I was there.”

    I missed the show and will listen today but reading this thread I broke out in a sweat and my heart is beating fast. This AM I go for my allergy shots- have been doing this for 15 years- and as I sit in the waiting room I watch the parade of young well-dressed reps, each exuding an endearing personality, carrying bags full of samples and/or a treat of hot coffee and donuts for the Dr. and his staff. They are wecomed. The chatter is friendly and even personal. I sign in with a funny pen and mark my next appointment on a paper provided with a drug company logos. Pencils and pens stick out of mugs with more logos. I grab a tissue to wipe my runny nose from a box with a drug company logos. The Dr’s rooms are fillled with such “chochkas”.

    To be sure I have walked out with my free samples. A tiny bottle of nasal spray, last time I checked which was several years ago, was retailing for $57. I have no idea how this price has increased, which surely it has since, because the price is masked through my drug plan.

    I am well aware, being so sensitive, that drugs can exacerbate the very symptoms that they are supposed to relieve. I am so sorry and frightened by Kate’s tale, but warned again, to be careful and to watch out… watch out for your loved ones as well.

    Thanks for the great posts.

  54. After reading all the posts, I’ve re-listened to the show to see if perhaps I missed something. I did. She’s worse than I thought!

    Don’t get me wrong. I agree that Pharma is a corporate behemoth whose role in society is primarily to make money–lots of it. Lots and lots of it. To do that it spends to control Congress, the FDA, and to influence doctors, medical schools, pharmacies, and the whole healthcare delivery system. It’s power is far beyond what any institution of any kind ought to have and the primary potential countervailing powers: politics, the academy, the insurance industry are either in bed with Pharma or problematic in their own overweening power (i.e., the insurance industry).

    My disagreement is that she undermines the forcefulness of her critique by not being discriminating enough in her arguments. So many of the anecdotes that had our dear Chris reeling and tsk-tsk-tsking were hoary old chestnuts that have little basis in fact. For example, she claims that there is no difference between drug A and drug B if drug B is a slight chemical variation on drug A. She argues that the only reason that drug B is developed is when drug A is successful, drug B is designed as a “copycat” drug to share in drug A’s profits, or if drug A’s patent protection is running out. The argument is so off-base it’s neither right nor wrong, though mistaken. It’s beside the point.

    The problem with her charge is that it looks at the profit motives of Pharma as the basis for deciding on whether a drug is of any value or not. Well, that’s just plain silly. That’s like looking at your children and judging their value based on the motives that lay behind the act that brought them into existence. Now, I realize that most people are thinking only high-minded thoughts about the future of the human race, about the joys of parenthood, about keeping faith with the ancestors, and similar lofty things when they have sex. I, however, must confess that I had nothing so lofty on my mind during the act in which my children were conceived. I was bloddy EXCITED and having fun and full of love and lust. Do my kids therefore have less value because the motive behind their origin was not the good of humanity, but carnal satisfaction? (It’s ok. I can say this. I’m ordained.)

    Judge the drug on its effects, not on the motives that produced it. The body is not a machine. My body does not react to a drug the same way your body does. Ever so slight variations on a drug may make a copycat and bring oodles of filthy lucre to Pharma, but that copycat may save a life or make a person’s suffering more bearable (but, I forget, Marcia discounts the suffering of those whose pain is the result of a “life-style” disease, like depression, ADHD, obbsessive-compulsive disorder, and other neurological disorders she and Chris think are inventions of Pharma) That is the strange irony of capitalism: dirty profit motives can, indeed, lead to things that improve the life of the world. Sometimes.

    And that is why I’m mad at Marcia. Big Pharma is SO big and powerful that it is less and less subject to the laws of the free market. Markets are only free when there are countervailing powers that keep market actors from getting so powerful they eliminate market forces. Instead of driving that point home over and over and over again (with powerful, convincing evidence she marshalls with ease and great skill), she forays into anecdotal arguments and dredges up statistical studies that conceal rather than reveal the possible effectiveness or dangers of a drug.

    No, I’m sorry I must disagree with most of you who think this program was a decisive blow against Pharma. All her Pharmic opponents have to do is blow on the smoke she provided with her indiscriminate arguments to continue to obfuscate and blind the American people.

    Do it again, Chris. Big Pharma hardly had a glove laid on it. Some of us are still waiting for someone with a sling and five smooth stones to bring this giant down (a reference that I’m sure that my brother, Chris, will get).

    And Chris, acknowledge that your own biases against mental, emotional, and behavioral disorders and those who you think “create” them. We need the strongest arguments we can get against the drug industry; I’m afraid your prejudice in this matter weakens your usually marvelously clear thinking and trivializes those who suffer things you don’t believe in and strengthens those who exploit them, and us.

  55. “I mean, who would make a lightbulb that would work longer than the average lifespan of the person using it?”

    Somebody might

    This is not a minor quibble. “Everybody knows” that industry is rapacious yada yada. However, every time someone does something in an inefficient manner, that creates a market opportunity for someone else.

    Furthermore, drug companies have good reasons to prefer to market a cure if at all possible.

    Assuming they’re hedonically equivalent, the proper price for a cure is the discounted current value of the cost stream for the continuing therapy. However, pharma has an incentive to produce cures at this price rather than treatments, because pharma would severely discount potential profits from drugs that are due to go off patent. In other words, if $100 for a cure now is worth the same to the consumer as $10/year for 20 years for the ongoing therapy, they will be indifferent to whether to buy the cure or the therapy — but the drug company, who would get the whole $100 but who will only get a few years of the $10 because the drug will go off patent before 20 years are up, would hugely prefer the cure.

    -dk

  56. I enjoyed the show.

    Dr. Angell mentioned a research publication on clinical trials of antidepressants in which the authors obtained protected information from the FDA by using the Freedom of Information Act. The upshot of the paper was that the pharmaceutical companies were/are promoting their products by presenting cherry-picked results from a body of data that was altogether underwhelming. Could you provide the reference so I can read that paper.

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