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Big Pharma, Bad Medicine

Great title. Too bad it’s not my original, but this link will take you to the current issue of the Boston Review, and figuring we don’t see much of this magazine in Chicago, I’ll summarize its key points and hope (if you care a smidgen about your well-being) you’ll then read as much as you can endure without screaming.

The credentials of its authors are impeccable. Marcia Angell, MD, is the former editor-in-chief of the prestigious New England Journal of Medicine and current a senior lecturer at Harvard. Adrian Fugh-Berman, MD, is a professor of medicine at Georgetown University and directs PharmedOUT, which debates the collusion between medical education and Big Pharma. On the side of Big Pharma in the Boston Review debate, Emma D’Arcy is a so-called independent expert (who actually runs a PR firm with Big Pharma as her major client) on the relationship between academic medicine and Big Pharma. Dr. Angell dismisses Ms. D’Arcy as “being wrong on all fronts.” We’re not talking Reader’s Digest pleasantries here.

Here are some bullet points to whet your interest. Or to get enough information to challenge me, or any physician, who hands you a prescription for anything. Always bear in mind that Big Pharma is the single most profitable segment of our economy, and that although your prescription may seem financially “reasonable” with a ten or twenty dollar co-pay, the remaining $200 to $400 bill to your insurance company generates enormous profits for the Twelve Sisters of the industry (as well as dozens of new players).

• Big Pharma has an iron grip on academic medicine. Vast amounts of money are paid to medicals schools and medical school department chiefs to supply warm bodies for clinical studies of little value except to “prove” what the company wants them to prove. Generating results that please the company can mean millions of dollars in the coffers of everyone except you: the Big Pharma company, the medical school, and the pockets of “researchers.”

• Both the FDA and the NIH are compromised. Although ultimately the Food and Drug Administration (FDA) must give its stamp of approval before a new drug is released, virtually all the physician committee members have highly significant financial conflicts of interest with Big Pharma. And when the National Institutes of Health National Cholesterol Education Program decided to lower the LDL (bad cholesterol) number, which would determine when statin therapy should be initiated (thus putting millions of unsuspecting patients on statin drugs), virtually every physician involved in the NIH recommendation gained financially.

• Doctors are paid to “learn.” Like most professionals, physicians are expected to keep abreast of the latest developments in their field and accumulate CME (continuing medical education) credits. Although all other professionals, from beauticians to attorneys, pay for educational programs, doctors get theirs free, usually with food and sometimes even travel, via Big Pharma-sponsored “seminars” that are really subtle commercials for their products.

• Drug treatment for non-diseases. The subtlety of these seminars comes from the fact that although a specific drug may not be mentioned, diseases are literally created that can then be treated with the drug whose company is sponsoring the event. What these non-diseases have in common is this: they can usually be treated without drugs by making lifestyle changes and taking nutritional products. These non-diseases include high cholesterol, restless legs syndrome, social anxiety disorder, shift worker’s sleep disorder, and irritable bowel syndrome.

• Medical journals brought to you by…Big Pharma. The medical journals flooding a physician’s mailbox are virtually free to the physician and financially supported by Big Pharma. At one time, doctors flipped through pages of drug advertisements and the ads worked subliminally. These days, many journal articles themselves are ghostwritten by professional companies contracted by Big Pharma to massage data in order to make a new drug look good. The listed “physician authors” have signed off on the article (often without even reading it) for a juicy professional reviewing “stipend.”

• That will be $1,073 for 100 capsules. When they’re not creating new diseases to make money, Big Pharma is endlessly reconfiguring or changing the tablet strength of drugs about to go off-patent to generic (and far less expensive) status to avoid completely losing their cash cow. This allows them to extend their patent and keep the price high. Ambien (zolpidem) generic sells for $10.74 for 100 pills at Costco. Ambien CR (controlled release), a patent extender, sells for $599.18 per 100 pills (yes, over 50 times the generic price). Restoril (temazepam), another sleep aid, is generic in 15-mg and 30-mg tablets, selling for $24 per 100. The new Restoril 22.5-mg pill (“clinically proven most effective” says the drug rep handing me “studies from a major medical school to prove it”) sells for $1,073 per 100 caps (!).

• Generic doesn’t always mean inexpensive. Now the generic manufacturers themselves can smell the meat a-cookin’. They contract to be the “exclusive generic manufacturers” of a drug. When that drug goes off patent, the price stays the same or at best goes down a couple of percentage points.

I’m sure you’re getting the drift here. It’s essential that you the consumer see the other side of Big Pharma, the side behind every prescription–needed and not needed–your doctor writes.

I can’t believe the nerve of the TV drug commercials (banned worldwide except in the US and South Africa) shamelessly touting drugs in ways that make snake oil salesmen from the 19th century look like Albert Schweitzer. At least snake oil is high in anti-inflammatory essential fatty acids.

Next week: I get hypnotized by a pharmaceutical market research firm.

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