A *slightly* biased old research paper.
Please see my accompanying commentary “Big Pharma and a Bipolar Life” here: https://emilysimonelukaszek.wordpress.com/2015/04/16/big-pharma-and-a-bipolar-life/
Words >Drugs in Your Mouth
How the pharmaceutical industry deceives us all for profit
By Emily Simone Lukaszek
In the 1980s, the early stages in recognising the pharmaceutical industry, praise for their discoveries was heartfelt. The dedication of Dr. Bert Spilker’s book on drug discovery and development reads:
To everyone in the drug industry who helps discover, develop, produce, and market new drugs of medical value.
A lot has changed since then. Namely the term “medical value” dropped off somewhere along the way as the industry stumbled upon the door to personal gain. Between 1980 and 2003 in the USA, the industry dominated charts, ranking by far the most profitable industry, with drug sales tripling in that time span (Angell, 3). It now rakes in some $200 billion a year. (Just how much is $200 billion? That’s Donald Trump’s newly renovated estate priced at $125 million –160 times over.) For nearly thirty years, the pharmaceutical industry has increasingly demonstrated blatant disregard for industry regulations through unethical marketing practices. Favouring profit above patients’ well-being has continually corrupted the medical, and even social, world. These pages highlight topics of unethical behaviours, lies, and secrecy in the marketing industry: Direct-to-Consumer Advertising; a deep relationship between drug companies and physicians that includes cash; selling the industry in the form of manipulative “education”; and controlling research of drugs and their results to produce the right results for the market. Overall, a prevalent lack of enforced guidelines in all areas only aids the industry in their unethically, and arguably illegal, activities.
Direct-to-Consumer (DTC) advertising is no more than marketing drugs directly to the source of income: the patients. This form of advertising appears most often on TV, and in magazines. Since 1997, when the Food and Drug Administration loosened guidelines on mandatory information for DTC, TV ads increased dramatically and rapidly, from 25% of TV ads in 1997 to 64% in 2001 (Angell, 123-26). Most of the drugs advertised are copycat drugs; producing variants of a well-used drug guarantees profit and is much less costly than creating a brand-new one. Alan F. Holmer stated in New England Journal of Medicine such ads are beneficial to the industry, because they get people to see their doctors for symptoms they previously did not recognize or thought untreatable (526). A common way to advertise impotence drugs (such as Viagra) is through sports events, and drug companies even sign contracts with teams, often paying six figures to advertise their drug at half-time and in the stadium (Angell, 116). Some companies use well-known media figures to film “stealth ads”; advertisements disguised as journalism reports. Still others pay celebrities to casually mention drug names on screen.
Regulations state the FDA must review the industry’s ad campaigns and return a letter highlighting necessary changes, but this is hardly enforced. Entirely under-staffed for the amount of work required (the FDA’s review panel consists of 30 people, with 34,000 DTC ads submitted in 2001), campaigns often finish before receiving any feedback, thus completely undermining the notion (Angell, 123-26). Another rising form of DTC is drug companies funding patient groups, which offer information about and support to those whom the disease affects. They are supposed to be publicly funded, but recently funding increasingly comes from drug companies. Generally, the groups receiving more than 20% of their funding from industry are for conditions affecting a very large number of people, and requiring long-term treatment –in fact, studies show the industry hardly funds groups for fatal conditions (Aldhous, 20-21). Evidently, pharmaceutical companies want to guarantee profits by investing where there is a promise for ongoing market.
No matter how the industry chooses to put it, nothing changes the truth: it is a regular and somehow legal practice for pharmaceutical companies to offer big fat bribes to doctors, and consumers pay for it all through rising drug prices. In 2001, 88,000 pharmaceutical sales representatives visited doctors’ offices to distribute $11 billion in free samples, promote and advertise products, and even deliver gifts. The Journal of the American Medical Association wrote: “Medicine allows payments from a company to an individual who decides whether and how often to use products produced by the company.” (Ross et al, 1216.) It’s rather perplexing why and how this practice can be justified in medicine, when in any other profession, such as law and education, very strict guidelines apply. Industry “gifts” include expensive dinners, box office seats to the most publicized sporting events, all-inclusive family vacations, and yes, cold hard cash. The American Medical Association suggests a limit of $100 to all industry gifts to physicians, but offers no suggestions of the frequency of such a gift (AMA website). Records also show most companies do not even abide by this limit (Ross et al, 1218). Doctors also accept large payments from drug companies to let their sales reps shadow them all day. The sales reps remain present as they see patients, and may also be invited into operating and procedure rooms, and even remain present during physician exams under the implied assumption that they are doctors (nothing is said otherwise, and the reps even offer treatment advice.) (Angell, 127.)
The pharmaceutical industry goes to all lengths to ensure their drugs are prescribed, and another example of this is their involvement with education. We must first understand this concept: the FDA approves drugs for a specific use and it is illegal to market drugs for any different one. Doctors, on the other hand, can prescribe for whatever purpose they choose. It is therefore beneficial to the drug companies for doctors to prescribe their drug as much as possible. A drug having multiple purposes for prescription would heavily expand use, thus increase sales.
This is where “education” comes in. Drug companies sponsor educational events with no further intention than getting doctors to use their drugs, and use them a lot. They provide proof from their self-sponsored, biased studies. Continuing medical education is mandatory in most states to maintain a medical license. About a hundred private, for-profit firms hired by drug companies—some of them even owned by advertising agencies—have legal accreditation to host CME seminars (Angell, 138). At these events, the drug companies often provide their own paid consultants as speakers, and treat doctors lavishly with activities such as golfing, skiing, and four-course meals.
With FDA approval comes another marketing gimmick: research. FDA does not actually study the drugs: that’s left up to the company (Avorn, 71). So really, they have the green light to do whatever they please. Companies often do minimally, if at all, acceptable trials and studies, write articles skewing the results in their favour, and then pay academic “authors” to sign their name on it (Kowalczyk). After a drug has been approved by the FDA, (the key word being after) “commitment studies” must be done to assess the risk of serious side effects. As of 2003, only 50% of these were fully done (Angell, 163). The FDA of course has the authority to pull the drugs off the market, and they never have.
Pharmaceutical companies are businesses, and the first and foremost goal in any business is to make money. But where do we draw the line? Major advertising companies like Madison Ave giants Omnicom, WPP, and Interpublic are now buying into the pharmaceutical industry (Angell, 166). When will enough be enough? Why is corruption to this extent aided, not abolished? These are questions we as a society must answer and solve quickly. The pharmaceutical industry no longer values saving lives: its unethical regime claims lives by proxy of greed. Formal laws and harsh penalties must counteract this jovial system of suggestion and laissez-faire. Consciously ignored non-compliance is unacceptable, especially when consequences are so obvious and dire.
If the drugs really are as amazing as their companies claim, there would be no need to put billions of dollars into marketing, advertising, and bribery. The industry scammed us, and we all got suckered into it.
Aldhous, Peter and Jessica Marshall. “Swallowing the Best Advice?” NewScientist 192.2575 (October 28, 2006): 18-22.
American Medical Association Website. “Gifts to Physicians from Industry.” <http://www.ama-assn.org/ama/pub/category/8484.html> Accessed November 26, 2007.
Angell, Marcia. The Truth About Drug Companies: How they deceive us and what to do about it. New York: Random House, 2004.
Avorn, Jerry. Powerful Medicines: The benefits, risks, and costs of prescription drugs. New York: Alfred A. Knopf, 2004.
Berenson, Alex. “Eli Lilly Said to Play Down Risk of Top Pill.” The New York Times. December 17, 2006: Business.
Bodil Als-Nielsen et al. “Association of Funding and Conclusions in Randomized Drug Trials.” The Journal of the American Medical Association. (August 20, 2003): 921.
Brennan, Troyen A. and Michelle M. Mello. “Sunshine Laws and the Pharmaceutical Industry.” The Journal of the American Medical Association. 297.11 (March 21, 2007): 1255-1257.
CenterWatch website. “Phase IV Market Steams Ahead.” <http://www.centerwatch.com/bookstore/backissues/vol9iss10.html> Accessed December 4, 2007.
Holmer, Alan F. “Direct-to-Consumer Advertising –Strengthening Our Health Care System.” New England Journal of Medicine. (February 14, 2002): 526.
Joseph S. Ross et al. “Pharmaceutical Company Payments to Physicians: Early Experiences with Disclosure Laws in Vermont and Minnesota.” The Journal of the American Medical Association. (March 21, 2007): 1216-1228.
Kowalczyk, Liz. “Drug Company Push on Doctors Disclosed.” Boston Globe. May 19, 2002: A1.
Spilker, Bert. Multinational Drug Companies: Issues in Drug Discovery and Development. New York: Raven Press, Ltd., 1989. 419-459.