Ten Reasons To Distrust Drug Companies

A reader of this blog who wants to be identified as Doctor’s Daughter wrote the following editorial and submitted it to KevinMD, which turned it down. KevinMD is aimed at doctors. One recent article (“Why 99% of health care should be angry“) said this: “The real top earners in health care, however, are not physicians, but executives of big corporations, non-profit and especially for profit.” Here is what Doctor’s Daughter wrote:

(On Kevin MD’s website there was a recent piece entitled “How Can Pharma Earn the Trust of Patients?”  which was submitted by Richard Meyer, the executive director of Online Strategic Solutions, which develops strategies for companies that engage in direct-to-consumer marketing.  . .  I feel compelled to offer a different viewpoint, focused on pharma’s actual business practices.)

Far too many pharmaceutical companies have:

1.  Spent more money on marketing than on honest research and development.

2.  Set exorbitant prices for drugs.  For example, they have engaged in price-gouging for cancer drugs, with many costing more than $50,000 annually.

3.  Tried to medicalize almost everything and, quelle surprise, they have a pill for that!  Few of these drugs do anything to cure the condition; they just alleviate the symptoms.

4.  Undermined the independence of guideline panels by making sure that the panels are filled with pharma friendly researchers and clinicians.

5.  Unduly influenced the judgment of physicians and  tried to undermine their integrity with gifts and cash.

6.  Prevented lower-priced generics from coming on the market with “pay to delay” agreements and by other means.

7.  Chosen profits over safety (remember the Heparin scandal?).

8.  Designed studies that only report the supposed benefit of a particular drug and suppress information about adverse effects.

9.  Exercised undue influence over panels that review the efficacy and safety of drugs.

10.  Have continued to spend billions on advertising by saturating prime-time TV with Direct-To-Consumer ads to “Ask your doctor…”

With these kinds of abusive practices, should anybody trust these guys?

A reasonable list of complaints.

11 Replies to “Ten Reasons To Distrust Drug Companies”

  1. Great list! I especially like # 3, and of course BigPharma doesn’t stop once they create a scary name for a previously unrecognized disease, or even after they lobby the FDA to approve their new drug for their new made-up disease. They then go to work lobbying the FDA to change the guidelines, so that many more millions of people will get prescriptions for the new drugs to treat the new diseases. Why doesn’t the FDA ever de-classify any of these fictional diseases?

  2. Whether it’s intentional or unconscious, the numbing repetition of TV commercials suggests to me an additional tactic. It isn’t just the drug being promoted, it’s the disease. How many people might even succumb to some condition repeatedly ‘plugged’ as common?

    There’s also the “Ask your Doctor if X-drug is right for you!” which affirms the Doc as an authority figure, garners appointments for him, and presumably produces celebrity (“as seen on TV”) prescriptions, when doing nothing might be a better option. (Truth in advertising: “Nothing works better than ____.”)

    And now there’s that grey-haired retiree on our screens, getting down with his motorcycle on the salt flats. Sure, 60 may be the new 50 (or some such), and so-called ‘active lifestyles’ are becoming more common. But having seen these sorts of commercials, how many now on Medicare (“Free!) will take the commercial dare and engage in high risk activities? Dumping his bike at Bonneville could land the guy in just the hospital which shot the commercial!

    I don’t think all the above is necessarily intentional. But why would it not happen?

  3. #1 and #10 aren’t reasonable. If and when drug companies have a drug that actually can make people’s lives better, how the potential customers supposed to know about it if the companies don’t advertise? It’s entirely conceivable that spending lots of money – even billions of dollars – on advertising might both (a) make the drugs being advertised cheaper and/or better, and (b) make customers better off.

    Ad spending does not conflict with the ability to spend on “honest research and development” nor is there any logical reason it would be better to spend more on R&D than on ads. A well-designed ad campaign “pays for itself”, bringing in more than enough extra revenue to cover the cost of the campaign. Which means the company that runs good ads has *more* money to spend on R&D (or other appropriate expenses) than they would have without running the ads.

    Speaking as a consumer, I’m glad companies run direct-to-consumer ads, but I wish the companies were legally allowed to tell me exactly what the product does and that I was legally allowed to go buy it in stores without going through a doctor.

  4. Glen, ad spending aimed at non-physicians by pharmaceutical companies used to be illegal, for good reason in my opinion. I think your points are optimistic to the point of Pollyannaism.

    Once stocked with right-wing justices, the Court gave corporations — “people” who exist solely as a legal fiction — the same free speech rights that actual citizens have. Hence the billions of dollars spent medicalizing children with too much spunk. And don’t get me started on the symbiosis between Big Medicine’s voracious diabetes/dialysis complex and endless supply of human chum created by Archer/Daniels/Midland-General Foods-Nabisco-Coca Cola etc etc etc.

    You might think that the fact that fake people can out-shout folks like Seth a billion to one has raised the level of discourse in America and improved the lives of non-imaginary citizens. I’d sooner believe in unicorns.

  5. Tom makes the excellent point that direct-to-consumer ads used to be illegal in this country, like they still are in most other countries including Europe and Canada. A good case can be made that the FDA (or Congress) should revisit this issue in the USA. After all, there’s a big difference (or should be) between, say, consumer ads for fashion wear or lipstick and the marketing of prescription drugs that are costly to begin with and may very well cause adverse effects requiring even more expensive medical interventions. No wonder government programs such as Medicare and Medicaid are going broke.

    None of this means that pharma companies couldn’t cheaply publish objective information about their products (say on their websites) as long as they eliminated the hype and fully disclosed the potential adverse effects. And if they stopped all consumer TV advertising and direct marketing to doctors, imagine how much less expensive some truly useful medicines could be.

    But perhaps Congress has become too far over-lobbied and compromised by campaign contributions (from you-know-who) to have the backbone and common sense to prohibit TV advertising of prescription drugs. If that turns out to be the case, then maybe the IRS should take the initiative to begin disallowing pharma companies’ deduction of these costs as “ordinary and necessary” business expenses on their tax returns. In light of experience, I suggest the prevailing view should be that direct-to-consumer advertising of drugs, although it has most unfortunately become ordinary, should in no way be necessary; and most certainly is not good public policy.

  6. The “right of corporations to speak” is just the right of *people* to speak through corporations. The ACLU is a corporation. Amnesty International is a corporation. Prior to that ruling, the government had effectively banned large swaths of *political speech* – exactly the sort of speech the constitution was meant to protect. That ruling makes it easier for people to get the word out, in any direction. The answer to bad speech is more speech, not laws that make whole categories of speech illegal.

    “Ask your doctor” ads are a second-best solution. The real problem here is that doctors have the prescription monopoly. If pharmacists could sell you drugs without a doctor’s prescription (as is done in Mexico), the doctors would have less power *and* customers would have more ability to get medicine cheaply when they need it. We should make *all* drugs “over the counter”, make FDA approval voluntary, and let companies market freely to consumers. Competition would then drive down the cost and improve the effectiveness of drugs. The reason we see so little innovation and such high costs in medicine today is that everything medicine-related has to go through the FDA *and* through doctors; there is no opportunity for a tiny startup that comes up with some new treatment that *might* help people with some rare disease to start selling it on a small scale and grow organically until lots of people see the benefit or until it gets outcompeted by some better solution. The fact that you have to spend billions of dollars satisfying the FDA *and* more billions marketing to the doctors, effectively turning doctors into your sales force, makes real innovation rare and denies effective help to anybody whose disease only affects a few people.

    Real innovation has risks associated with it. We *need* innovation, so we need to accept some level of risk. Trying to eliminate all risk in advance is the riskiest course of all.

    1. Glen, giving corporations “free speech” amounts to giving defenders of the status quo more power. I think they have enough power already.

      Yes, FDA regulation and the need for prescriptions reduce drug company innovation. I agree. But drug companies themselves reduce innovation. They reduce the search for non-drug solutions. Which I for one have found enormously helpful. In the case of diagnostic devices, I agree completely. FDA approval impedes innovation, with no significant benefits.

  7. With regard to “free speech”, incumbents in congress get their 98% reelection rate in large part because they already have power, goodies to auction off and name recognition. Incumbents don’t *need* big contributions to win; challengers to the status quo do. If we decontrolled “political speech” and let anybody contribute however much they want to any candidate, we’d see better candidates. Right now we have this weird situation where if you’re rich you can spend as much as you want on your *own* campaign but only a trivial amount on somebody else’s. As a result, we tend to get a lot of rich nitwits running for office even when *they themselves* know they aren’t the best man for the job. Under freedom, a really good candidate would only have to win over *one* crazy billionaire – say, Ross Perot – in order to get a seat at the table. Under regulation, we instead get Ross *actually running*, which isn’t good for anybody. 🙂

    I agree that the status quo reduces the search for non-drug solutions. But it also reduces the search for improved with-drug solutions. We’re free to do n=1 experiments with light and vitamins and flax-seed oil but we’re not free to do n=1 experiments with, say, Prozac. Or, heck, LSD. We mostly learn new things about prescription drugs through big, official, slow, expensive experiments, and trying to learn more about controlled drugs can actually get patients sent to prison. That seems like a wasted opportunity all around – drugs that *actually work well* – either for prevention or for cure – would be a godsend and we don’t really have enough of them.

  8. Sure. The ugly side of pharmaceutical companies is… ugly. But it is also true that none of us have any fear whatsoever of many diseases that not long ago were deadly. Where is the reasonable middle ground?

    1. Andrew, the answer to your question (“if you ended drug marketing wouldn’t that make patients more dependent on doctors for information?”) is yes. But patients have other sources of information (on the Internet) less biased than their doctor (or should I say: even their doctor?). Sources of information who surely haven’t accepted gifts and free samples from drug company representatives.

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