When you add it all together, things have not been going well for the pharmaceutical industry lately. There has been a spate of high profile drug disasters, such as the withdrawal of painkiller Vioxx and daily reports of malfeasance of all sorts by drug companies, including lobbying governments for coverage for vaccines, employing patient groups to do their dirty work and otherwise putting undue influence on the prescribing of medicine. In addition, several recently published, high-profile books by pharmacy insiders have unmasked the tricks used everyday to sway our physicians into prescribing certain drugs.
But what has attracted the indignation and is beginning to arouse the distrust of the general public is the in-your-face marketing of direct-to-consumer drug ads that has risen 500 percent over the last five years. You can’t turn on a TV without being assaulted by ads urging you to “Ask your doctor...” for just about everything.
Big Bucks, Big Pharma, a new DVD produced by the Media Education Foundation, attacks these concerns head-on in a 46-minute documentary. And it does a fabulous job for both those who know a lot about this stuff and others coming to it for the first time. The documentary’s main strength is that it talks to those working at the heart of the medical establishment – physicians, pharmacists and pharma salespeople – who have observed, close hand, the excesses of the pharmaceutical industry. Progressive American journalist and radio broadcaster Amy Goodman interviews, among others, Marcia Angell, former editor of the New England Journal of Medicine, Dr. Bob Goodman, founder of No Free Lunch and Gene Carbona, a former Merck salesman.
The single driving question behind this documentary is this: “How is the influence of the most profitable companies in the world affecting our thinking about our health and well being?” It’s a good question and the answers will turn even the most pharma-friendly people into pharma skeptics. Selling drugs is about creating a brand identity, a feel-good emotion that is emotive, rather than informative, involving all the power of public relations and advertising to create that feeling. While the industry brags that its ads educate consumers, no one is buying that guff, especially Marcia Angell, who says, “They are no more in the business of educating the public than a beer company is in the business of educating people about alcoholism.”
But all that advertising is having an effect and the industry spends upwards of $3 billion per year in the US trying to convince us to buy their drugs. Bob Goodman (www.nofreelunch.org) says that the marketing on TV is so effective that “Patients come in and ask for stuff they don’t even know what it’s for.” Now that’s effective.
One of the strongest messages in the documentary is that we must get rid of our preferences for “New and Improved” when it comes to prescription drugs. What propels the market for drugs is the hope for the miraculous cure, the wonder drug, and many people assume if something is new, it must be better. The problem, as Marcia Angell explains, is that newer drugs do not have to prove themselves to be any better than older ones, and frankly, most of the new drugs are not that new. An analysis of new drugs in the US from 1998 to 2004 found that only 14 percent of the newly approved drugs were classified as being a medical advance.
For me, someone steeped in this stuff, the most interesting part of the documentary was listening to Gene Carbona, a former salesman for drug giant Merck. Carbona is now working to sell The Medical Letter (www.medicalletter.org), one of the top sources of independent (read: not funded by drug companies) information for doctors in the world. As an insider with street cred, he’s someone you’re likely to believe when he tells you that, despite all that pharma says about being in the business of saving lives, etc, “Marketing is the real name of the game.”
He tells a story about being a sales rep for Prilosec (what we call Losec in Canada) – an acid suppression or heartburn drug – and describes how the drug was going to lose its patent and the company licensed a drug that was almost an exact replica (Nexium). He and his colleagues had the task of basically convincing doctors that the newer drug was better. With a rare peek at the inner workings of the drug marketing juggernaut, he notes, “In the final two years [as the patent on Prilosec was expiring], we were trained to cannibalize our markets, that is, shift the doctors from the older drug to the newer drug.”
That’s what it’s all about.
The documentary hits its stride when it talks about disease mongering and the role of the pharmaceutical industry in creating and shaping diseases: how peoples’ blood pressure went from “normal” to “high” overnight and where yesterday you didn’t have a cholesterol problem, but you have one today. Advertising drugs is one thing, but advertising health conditions is selling the sickness in order to capitalize on the cure.
Bob Goodman says that, of all the things that industry does, the one thing that you could say is evil is its medicalizing something that is part of everyday life. “A person who is not yet a patient sits down to watch the evening news and after a few commercials says, ‘I’m not as healthy as I thought…’”
It doesn’t have to be this way. As this documentary so clearly and simply shows, we need to become “healthy skeptics” and be better prepared to face a world where disease is being sold and drug companies are bankrolling the “education” of the general public through advertising both drugs and diseases.
Alan Cassels is a drug policy researcher at the University of Victoria and co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. His new book, The ABC’s of Disease Mongering: A Guide to Drugs and Disorders, is available in stores this month. (See feature article in this issue.)
Big Bucks Big Pharma DVD is available at www.bigbucksbigpharma.org