A tough pill to swallow
"Ask your doctor." That solid, much-heard phrase used to work for me, redeeming even the most absurd pharmaceutical ad. The drug companies seemed to be saying, "Hey, we have to hype, but ask your doctor — you can trust her.'' So I shrugged off the syrupy assault, the pompous voice-over, those beach and sky backdrops, that Icelandic saga of side effects.
Our world is full of medical madness, right? As Steve Martin wrote in a parody of drug-label warnings: "May induce a tendency to compulsively repeat the phrase 'no can do.' This drug may cause visions of the Virgin Mary to appear in treetops. If this happens, open a souvenir shop."
Surely, doctors do say "no can do" to overblown, ineffective meds. But guess how many of us see a drug in an ad, ask for it, and get a prescription? That would be 87 percent. No wonder the drug companies suggest, "Ask your doctor"!
My naiveté took a thrashing with each book today, and it started with that stat from a 1999 Prevention magazine study noted in Big Pharma: Exposing the Global Healthcare Agenda (Carroll & Graf, 2006).
British gadfly author Jacky Law reminds us of a basic fact here. Pharmaceutical companies are businesses first, not institutions bent on bettering our health. Still, I was shocked to learn they spend twice as much on marketing as on R&D. "The human race can survive perfectly well without an endless supply of new drugs," Law writes, "but the corporations that produce them can't."
And so they shamelessly retrofit old products as new ones and push ever more "me-too" drugs onto the market. Here's how Stephen Colbert puts it, riffing on AstraZeneca's cholesterol-fighting Crestor, a wannabe for Pfizer's Lipitor: It's "a great breakthrough in the battle to find things to prescribe to people who don't need them."
So are doctors rooked by the ads, too, then? No, it's potentially much more insidious than that. Drug companies have so much cash and clout — a decade back, the top 10 made more profits than the other Fortune 500 combined — they can cover every conceivable base. They fund and steer research, put doctors and medical schools on the payroll, infiltrate the FDA, and buy off endless lawsuits: 66 percent of all US fraud cases target drug companies.
Several physician-authors, each apoplectic at the sheer scale of influence and deceit, have tried to write the "Fast Food Nation" equivalent for the industry. "Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients'' (Faber and Faber, 2013) is the newest salvo. London-based Ben Goldacre hopes "your rage might swell." He says doctors prescribe these drugs, not because they're in on some conspiracy, but because they're unwittingly working off biased research. For instance, companies routinely fund seven studies of a drug, but only publish two — the best two. And so "contextual information about failure is just brushed under the carpet."
But what about academic journals? Aren't they reliable watchdogs? No, they're more like "infomercials" for the industry, according to "Overdosed America: The Broken Promise of American Medicine" (HarperPerennial, 2008). The author is another aghast doctor, John Abrahamson, who teaches at Harvard Medical School. Just watch him go: "Rigging medical studies, misrepresenting research results published in even the most influential medical journals, and withholding the findings of whole studies that don't come out in a sponsor's favor have all become the accepted norm in commercially sponsored medical research."
Big Pharma does all this to boost market share by converting the "worried well into the worried sick," write Ray Moynihan and Alan Cassels in "Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients" (Nation Books, 2005). Let's add specifics for spice. Remember when osteoporosis was the flavor of the month? In an ad for Fosamax, Merck said a whopping 50 percent of women reduced their risk of hip fracture by using the drug. This stat went viral before you could go viral, driving millions to ask for a scrip. Now the fact check: It hails from a study of 100 women, where two in the placebo group broke a hip versus one in the Fosamax group. In relative terms, the drug reduced the risk of fracture 50 percent. In actual terms, it was 1 percent.
Let's circle back to Lipitor. In 2011, it was the best-selling drug in the world. In 1998, 13 million people were on it. By 2004, it had jumped to 40 million. Why the hike? Because the National Institutes of Health lowered (again) the levels of cholesterol that qualified for treatment, thereby tripling the pool of patients. At first I read this and thought, "Well, they must know best; it must have to do with the obesity epidemic.'' But then I read that eight of the nine on that NIH panel had significant ties to the pharmaceutical industry.
On to another irate practitioner, a Bangor, Wales, psychiatrist named David Healy. His Pharmageddon" (University of California Press, 2012) explains how a few generations ago the pharmaceutical industry used to be "a junior partner to the medical establishment." It targeted diseases, tried for bold cures, and we got penicillin and antibiotics — but, on the flip side, it wasn't soundly regulated. When the thalidomide scandal broke in 1962, Senator Estes Kefauver passed the "Drug Efficacy Amendment." It required drug companies to show proof their products actually worked and were safe. This raised the bar for rolling out big cures, and so Big Pharma rechanneled its energies into the broader field of chronic disease management. That's where the payoff was. After all, cure a customer, lose a customer.
Where is the FDA in all of this? It came as a relief to turn to the more uplifting "Protecting America's Health: The FDA, Business, and One Hundred Years of Regulation'' (University of North Carolina Press, 2004). Founded by Teddy Roosevelt in 1906, the agency debuted as the Bureau of Chemistry in the Department of Agriculture. In its early incarnation, it swept house, ending harmful quackery like Mrs. Winslow's Soothing Syrup (aimed at teething children, main ingredient opium). And it banned companies from making false claims, like Listerine, which bragged it prevented tuberculosis. Author Philip J. Hilts is not an apologist for the FDA — he sees too much industry sway — but he also says that, despite immense corporate and political pressure, it's done much good.
I have asthma, and every day I take a Singulair. It's made by Merck, and it helps me enormously. As I read these books, I had to remember the obvious point that great things come from the pharmaceutical industry, notwithstanding the huge negatives. So here's a little pill of hope for you: "The Truth About the Drug Companies: How They Deceive Us and What to Do About It" (Random House, 2005) by Marcia Angell, M.D., former editor of the New England Journal of Medicine.
Angell searches for our better angels; we should get Big Pharma out of medical school sponsorships, she says, empower the independence of the FDA by dropping the conflict of interest "user fees" the industry pays to it. We should also force the companies to prove each "new" drug adds definable value, which would scotch many me-too candidates. Finally, because they get many tax breaks and special favors, Big Pharma should be treated like public utilities, which must be transparent for the public good. Can these reforms really work? I don't know. Ask your doctor.