Health Care Crisis: Marketing of drugs

Television ads make it apparently obvious that pharmaceuticals are the answer to life's problems. Doesn't everyone want to fall asleep with a butterfly on their pillow? Doesn't everyone want to make their foggy life view clear and happy with antihistamines? The message is clear: life is miserable and a simple pill with make it all well again.

While the truly ill, with the help of their physician, will find a grain of truth in the slick message, there's a larger issue to consider: prescription drugs are big business and the bottom line is not always in the best interest of health. The Center for Disease control estimates that about 130 million Americans will use prescribed medications every month. Far more medicine per person is consumed by Americans than in any other place in the world.

It is reported that drug companies spend $4 billion every year to market drugs directly to consumers.

Targeting physicians

Is it working? A recent study sent actors to 152 doctors' offices where they pretended to be patients, complaining of stress and fatigue. When the "patients" specifically asked for Paxil, a brand-name antidepressant, 55 percent were given prescriptions and 50 percent were diagnosed with depression.

Reported in the Journal of American Medical Association, the study concluded, "Patients'" requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse." In other words, advertising really can be hazardous to your health.

Media advertising is just the tip of the iceberg. When State Senator Alan Bates, a medical doctor, was asked if he's ever solicited by drug companies, he said, "Only about four times a day." Aggressive drug promotion is part of a physician's daily life.

An August, 2006, study published in the Annals of Internal Medicine demonstrated drug companies' product promotion goes far beyond television and magazine ads. It is estimated the drug industry spends $18.5 billion on promotion to doctors alone. That comes out to about $30,000 a year for every physician in the United States.

Many state licensing boards require physicians to regularly upgrade their medical skills through continuing medical education. Continuing education for physicians was run by medical schools in the past. Now, Medical Education and Communications Committees run educational conferences in enticing and often exotic locations. The drug companies foot the bill for these mostly free "educational conferences" through "unrestricted educational grants." These conferences give the companies access to multitudes of doctors in a single location.

"Medical education drives this market," states a Parke-Davis business plan.

Marketing medicine

Papers filed in a lawsuit against Pfizer are now part of the Drug Industry Document Archive at the University of California. They reveal creative promotion tactics, including contracting with MECC's to develop articles and reviews for medical journals to promote their products. Parke-Davis paid an MECC $13,375 to $18,000 for each article published. The MECC then paid $1,000 to friendly doctors and pharmacists to "ghostwrite" journal articles, thereby making the material appear independent of the drug company.

The corporate publication strategy also included drug company-sponsored small trials of their drug. They would only publish the results if the trials met company expectations. Between 1993""97 Parke-Davis paid between $10,150 to $158,250 in honoraria, research and educational grants to 14 doctors labeled as "thought leaders," those whose opinions influenced the prescribing pattern of other doctors.

The Drug Industry Document Archives also show how Warner-Lambert influenced physician prescriptions of their epilepsy drug Neurontin by keeping track of their prescriptions and then rewarding high volume prescribers by paying them as speakers and for entering patients in clinical trials. Physicians were actively encouraged by sales representatives to prescribe the drug for off-label use, such as hyper-activity in children, thereby increasing sales.

Impact on consumers

A national surveillance project on outpatient drug safety developed by the Centers for Disease Control and Prevention, the Food and Drug Administration and the U.S. Consumer Product Safety Commission was published in the Journal of American Medical Association. It reports that more than 700,000 Americans go to the Emergency Room each year because of harmful reactions to some of the most widely prescribed medicines. The researchers note that this number very likely underestimates the actual number of people who have bad drug reactions because many are outside the hospital setting or are misdiagnosed. Most are over the age of 65.

A recent study reported on MSNBC found that when doctors prescribe new drugs, they most often aren't very thorough in their explanations detailing possible side-effects, drug interactions or the need for frequent physician monitoring. This highlights the need for better doctor-patient communication about medications. It also demonstrates the danger of both doctors recommending and patients requesting specific drugs without knowing all the pertinent information as a result of aggressive promotion.

Politics of medicine

There has been much discussion recently about how to lower costs of prescription drugs, particularly during this past election season. However, there's stiff opposition to these efforts. As Dr. Castillo, of Corvallis, says, "My fear is that just as the drug cartels in Colombia control the government, the drug companies have control of our government."

The European Union has been working on a system of Parallel Imports, allowing the same drug to be imported into a country when it sells at a lower price in another country. The same system has been working de facto for those in the United States who have defied government regulations and imported prescription drugs from Canada, despite fear tactics claiming any drugs from another country might be of a lesser quality.

Americans' faith in drug safety has been rocked in recent months. Multiple lawsuits for alleged deaths due to Vioxx are just one example. The FDA, the supposed Federal protector of public interest, is reeling from its own political scandals and accusations. Part of the problem lies with political appointees to the FDA. Lester Crawford recently resigned as head of the FDA when it was revealed he'd owned stock in a company regulated by the FDA. Other questionable actions have been traced to politically motivated decisions being forced upon the independent commission. Susan Walker and Dr. Frank Davidoff recently resigned as commissioners, stating that politics not science was the basis for recent FDA decisions.

But, Congress must take at least some responsibility for FDA failures. Dr. Furberg, member of an FDA advisory committee, said Congress has withheld both the necessary funds and the legal clout to guarantee the safety of our prescription drugs. Since 1997 drug companies committed to 1,231 post-marketing safety studies, all of which are still incomplete; over half, 797 of those studies, were never even started. Furberg said, "The problem isn't the FDA staff, the problem is the FDA leadership."

Costs to consumers

Medicare recipients also suffer from rising cost of drugs. The new Medicare drug insurance plan has a "doughnut hole, a surprise $2,850 gap in coverage that seniors will have to pay, which was intentionally put into the benefit to save money. This new Medicare drug coverage goes through privately-owned companies even though the Congressional Budget Office estimated that the administrative costs of intermediary private insurers would add nearly $5 billion a year (approximately 9 percent) to the cost of the program. The CBO projects that seniors will pay 60 to 80 percent more for prescription drugs than the Veterans Administration, which is allowed to negotiate with drug companies directly for lower prices because of their volume purchasing. If Congress had opted to put the drug plan through the existing Medicare system instead of private companies, the "doughnut hole" would not even exist. Savings from lower administrative costs and lower drug prices could have eliminated the "doughnut hole" and still saved the government money.

Bates said heathly lobbyists have varying degrees of influence.

"With the exception of the pharmaceuticals, they don't affect it very much. It's a train running away all by itself. They do heavily affect the pharmaceutical costs. They do at the federal and national level, secondary and state level. They are a significant factor in our high health care costs. It's not all black and white, but things are out of control. [On the Federal level] Medicare should be able to sit down and negotiate [drug] prices. The VA has that system that allows them to do that. Those laws need to be changed."

The big business of medicine clearly pays well. It is estimated that drug costs are increasing by approximately 15 percent per year. As drug companies consolidate, the new entities require increased earnings. Companies are producing new "blockbuster drugs," which sell for higher prices to larger populations.

Pharmaceutical influence

Many consider the pharmaceutical corporate approach to medicine as the bellwether of what is wrong with a market-based medical system, one which prizes the stockholder and the bottom line over the patient.

For the election cycle of 2004, campaign contributions from pharmaceuticals and health products sources just in the state of Oregon amounted to $728,506. Of 74 donors in that category 46, or 62 percent were from out of state. On a federal level for the same time period $291,586,037 was spent by health industries lobbies.

State Rep. Karen Minnis, R-Wood Village, received more than $23,000 in donations from pharmaceutical contributors. Pharmaceuticals gave $3,500 to Bates during the same time period. Republican candidate for governor, Ron Saxton received $25,000 from Jed Meese, owner of an Ashland vitamin and supplement manufacturing company. Gov. Ted Kulongoski received no pharmaceutical or health care contributions. Pharmaceuticals and health care in general give preponderantly to Republicans nationwide.