There is no Free Lunch

1
There is no Free Lunch

• Hrach Ike Kasaryan MSIV

2
Introduction

• Pills, who would have ever figured things so
  small could have a tremendous influence on
  medicine and could hold so much power

3
Introduction

• The Pharmaceutical industry has a tremendous
  influence over a variety aspects of Modern
  Medicine
• Sometimes the influence is very obvious and other
  times the influence is purposely hidden not to
  let any one know

4
There Long Reach

• Economy
• Government
• The Doctors
• The Journals
• The Public

5
Economy

• With their financial growth pharm companies have
  had a tremendous influence on the economy
• Stock markets have risen and dropped at news of
  what each company does
• Pharm Cos contributed heavily to the stock
  market boom and volatility of the nineties.

6
Economy

• Pharmaceuticals again ranked as the most
  profitable sector in the United States, topping
  the annual Fortune 500 ranking of America's top
  industries
• The pharmaceutical industry topped all three of
  Fortune magazine's measures of profitability for
  2001, making this decade the third in which the
  industry has been at or near the top in all the
  magazine's measures of profitability.

BMJ 20023241054
7
Economy

• Overall profits of Fortune 500 companies
  declined by 53 in 2001, while the top 10 US drug
  makers increased profits by 32 from 28bn to
  37bn, according to Public Citizen's analysis of
  the Fortune 500 data.
• the 10 drug companies in the list had the
  greatest return on revenues, reporting a profit
  of 18.5 cents for every dollar of sales, eight
  times higher than the median for all Fortune
  500 industries, which was 2.2 cents

BMJ 20023241054
8
Economy

• Their response
• The drugs industry says it needs extraordinary
  profits to fund risky research and development of
  new drugs and to absorb the high cost of drug
  failures in clinical trials.

9
Economy

• From the same previous article
• The time spent to develop a drug, not counting
  the months consumed by government review, has
  lengthened from about nine years in the 1980s to
  more than 11 years, according to the Tufts Center
  for the Study of Drug Development, and the cost
  has more than doubled, after adjustment for
  inflation, to 800m.
• Public Citizen notes that the Tufts Center gets
  money from drug companies and maintains that the
  centre's figures are inflated to justify high
  drug costs.

10
Economy.

• So what this infact means is the profits are
  greater than they are
• They fund those who are going to scrutinize the
  drug approval process
• This way they can force them to make the numbers
  inflated to justify the outrageous prices
• And incase there is someone their who wants to
  print other wise, they will just pull funding and
  have them fired
• Pretty convenient for them.

11
Economy

• In an article from the Associated Press in 2003,
  titled Roche Cuts Prices of AIDS Drug to
  Nations they were bragging about how they
  reduced there price of AIDS drugs to poor
  countries
• Mean while the journalist reveals that
• In some countries, such as Guatemala and
  Ukraine, the cost of Viracept was higher than in
  rich Switzerland.
• Almost 2000 more per year in a poor country

Associated Press, 13 February 2003
12
Economy

• Because market prospects, not health needs,
  drive production lines, drugs are developed for
  Western diseases while diseases of the developing
  world are ignored.
• Lack of profits dictated that eflornithine, a
  lifesaving drug needed by hundreds of thousands
  of people with sleeping sickness in Africa, was
  withdrawn from production in the 1990s this left
  doctors with a 50 year old, arsenic based
  drug-which is becoming increasingly ineffective
  and whose side effects kill 1 in 20 patients.

New York Times 2001 February 9.
13
Economy

• The nations four largest pharmacy benefit
  managers (PBMs) have used a pattern of illegal
  and secret dealings with major drug makers that
  have forced health plans and health care
  consumers to pay inflated prescription drug
  prices, according to a suit filed in March by
  AFSCME and the health care advocacy group
  Prescription Access Litigation Project.
• PBMs manage prescription drug benefit programs
  for employers, unions, health plans and other
  payers. They process hundreds of millions of
  pharmaceutical claims per year and manage drug
  benefit programs for more than 200 million
  Americans as a broker between these payers and
  the drug companies to help control the cost of
  drug coverage.

American Federation of Labor Website
14
Economy

• The suit, filed under Californias Unfair
  Competition Law, says the four PBMs have
  negotiated rebates from drug manufacturers and
  discounts from retail pharmaciesbut havent
  passed those savings on to health plans and
  consumers. Instead, they have used those savings
  to secure exploitative profits. In addition, the
  complaint says the PBMs developed a pricing
  system based on the Average Wholesale Price,
  widely considered an inflated sticker price set
  by the drug manufacturer.
• Justified profits indeed

15
There Long Reach

• Economy
• Government
• The Doctors
• The Journals
• The Public

16
Government

• Besides making outrageous amounts of money at the
  expense of the public, they have the influence to
  protect their money making processes
• Tremendous amount of effort is spent by the Pharm
  Cos to keep politicians and governments in their
  back pocket

17
Government

• A USA TODAY study revealed just how far their
  reach in the govt. goes
• More than half of the experts hired to advise
  the government on the safety and effectiveness of
  medicine have financial relationships with the
  pharmaceutical companies that will be helped or
  hurt by their decisions

USA Today September 25, 2000
18
Government

• These experts are hired to advise the Food and
  Drug Administration on which medicines should be
  approved for sale, what the warning labels should
  say and how studies of drugs should be designed.
• The experts are supposed to be independent, but
  USA TODAY found that 54 of the time, they have a
  direct financial interest in the drug or topic
  they are asked to evaluate.
• So even the FDA is in on the deal?

19
Government

• Federal law generally prohibits the FDA from
  using experts with financial conflicts of
  interest, but the FDA has waived the restriction
  more than 800 times since 1998.
• These experts, about 300 on 18 advisory
  committees, make decisions that affect the health
  of millions of Americans and billions of dollars
  in drugs sales.
• Everything these committee members say are taken
  as end all be all and are followed by the FDA
  to a T.

20
Government

• The article also showed that the FDA reveals when
  financial conflicts exist, but it has kept
  details secret since 1992, so it is not possible
  to determine the amount of money or the drug
  company involved.
• So what we know is only the tip of the iceburg

21
Government

• Some more facts USA TODAY uncovered
• At 92 of the meetings, at least one member had a
  financial conflict of interest.
• At 55 of meetings, half or more of the FDA
  advisers had conflicts of interest..
• At the 102 meetings dealing with the fate of a
  specific drug, 33 of the experts had a financial
  conflict.
• The blind trust of the public in the FDA being
  blatently abused.

22
Government

• From the same issue of USA Today another article
  describes the Pending approval process of the FDA
  to make Levaquin, Johnsons and Johnsons drug,
  the first line drug against Penicillin resistant
  Strep. Pneum.
• the FDA's Anti-Infective Drug Advisory Committee
  included some familiar faces to Johnson and
  Johnson
• At least two of the experts were paid
  consultants to the drug company and had worked on
  the very same medicine that they were being asked
  to evaluate for approval in an important new
  market

USA Today September 25, 2000
23
Government

• The committes consumer representative, Keith
  Rodvold, whose job it was to protect the
  consumers interest had the most extensive
  financial relationship with Johnson Johnson
• Rodvold advised the company on how to design and
  analyze the clinical trials that got the drug
  approved

24
Government

• When Rodvold and JJ were confronted by USA Today
  about these conflicts both parties declined to
  discuss any part of these topics.

25
Government

• Top 10 Recipients of Drug Company Contributions
  1999  2003In New Jersey Only
• NJ REPUBLICAN STATE COMMITTEE 348,300
• REPUBLICAN NATIONAL STATE ELECTIONS COMMITTEE
  315,000NJ
• DEMOCRATIC STATE COMMITTEE 262,600
• ASSEMBLY REPUBLICAN MAJORITY 155,850
• SENATE REPUBLICAN MAJORITY (2001-2003)112,250
• SENATE PRESIDENTS COMMITTEE (1999-2000) 77,050
• SENATE DEMOCRATIC MAJORITY 2001 68,500
• DORIA DEMOCRATIC LEADERSHIP FUND 51,350
• NEW DEMOCRATIC ASSEMBLY LEADERSHIP PAC 50,425
• ASSEMBLYMAN PAUL DIGAETANO (R-36)28,800
• SENATOR JOHN O. BENNETT (R-12)20,100

26
Government

• ..drug and nutritional supplement manufacturers
  ranked ninth among more than 80 industry groups
  in direct contributions to congressional
  candidates and political parties, according to
  Federal Election Commission records compiled by
  the Center for Responsive Politics.
• On top of that, drug manufacturers consistently
  rank among the top two industry groups in money
  spent to lobby Congress.
• 400 registered lobbyists -- nearly one for each
  of the 535 members of Congress

November 8, 2002 Los Angeles Times
27
Government

• In the months before Tuesday's elections, they
  used photographs of sick children and frail
  seniors to suggest that generic drugs would make
  them worse.

28
There Long Reach

• Economy
• Government
• The Doctors
• The Journals
• The Public

29
Doctors

• Doctors have been a major target of Pharm Cos.
• Especially by the infamous PHARM REP!!

Hey Big boy Perscribe any Zocor lately??
30
Doctors

• Some Physicians take everything the rep says as
  truth
• A study in Journal of General Internal Medicine
  in 1996
• Their objectives were to describe material
  distributed to physicians by pharmaceutical
  companies to describe characteristics of the
  drugs discussed in the material to determine
  whether the material complies with Food and Drug
  Administration (FDA) regulations and whether it
  contains promotional and educational
  characteristics.
• .

31
Doctors

• They found
• Forty-two percent of the items failed to comply
  with at least one of three FDA regulations
  assessed, including 17 items that discussed
  unapproved uses for drugs
• Only Thirty-nine percent of the items offered
  scientific support for their claims.

32
Doctors

• JAMA article The accuracy of drug information
  from pharmaceutical sales representatives
• Their objectives were to provide quantitative
  data about the accuracy of the information about
  drugs presented to physicians by pharmaceutical
  sales representatives
• Eleven percent of the statements made by
  pharmaceutical representatives about drugs
  contradicted information readily available to
  them.
• Physicians generally failed to recognize the
  inaccurate statements.

JAMA 273 (16) 1296
33
Doctors

• Chest article The effects of pharmaceutical firm
  enticements on physician prescribing patterns.
  There's no such thing as a free lunch
• They looked at the impact on physician
  prescribing patterns of pharmaceutical firms
  offering all-expenses-paid trips to popular
  sunbelt vacation sites to attend symposia
  sponsored by a pharmaceutical company

CHEST 1992 120 1270-1273
34
Doctors

• They tracked prescribing before and after the
  symposia
• significant increase in the prescribing pattern
  of both drugs occurred following the symposia.
• These changed prescribing patterns were also
  significantly different from the national usage
  patterns of the two drugs by hospitals with more
  than 500 beds and major medical centers over the
  same period of time

35
Doctors

• Influences on GPs' decision to prescribe new
  drugs-the importance of who says what.
• In the study, researchers asked 107 GPs in
  northwest England to explain how they made the
  decision to prescribe certain new drugs.
• The doctors were asked to describe the context in
  which they prescribed the new drugs, the reasons
  why the chose one drug instead of another, and
  how they obtained the information that influenced
  their decision

Fam Pract. 2003 Feb20(1)61-8.
36
Doctors

• They found most often GPs were initially
  introduced to new drugs through sales
  representatives
• Drug companies were also the greatest influence
  on the GPs decisions of which drugs to
  prescribe, followed by consultants and patient
  requests for specific treatments

37
Doctors

• While the doctors were generally wary of the drug
  industrys objectives, they tended to believe
  that its information would be selective but
  accurate.
• The GPs reported that they could generally spot
  misleading information, however, according to
  study findings only 17 percent of GPs sought out
  evidence from peer-reviewed journals before
  making prescribing decisions

38
Doctors

• Here is an exerpt from PharmRep.com a web site to
  help pharm reps sell
• How should a rep present a reprint using
  evidence-based medical findings? We know that all
  studies are imperfect. In fact, most are far from
  perfect because science is imperfect. Part of
  presenting our reprints is helping the physician
  determine whether the information in the study
  can be applied to his or her practice. In other
  words, translate statistical significance into
  clinical significance. Use the appropriate terms
  to talk with physicians about clinical
  significance. Our job is to use the information
  learned in the studies and to influence physician
  prescribing behavior

39
Doctors

• Right there in black and white is their mission
  statemet to influence physician prescribing
  behavior
• They are trained how to spot the lamb, the
  doctor with little time to read up or who doesnt
  want to read up and feed them what they want to
  hear
• They are trained to spot the male or female who
  would change pattern of perscribing simply to get
  the social interaction with the pharm rep (wink
  wink)

40
Doctors

• Here is another exerpt from pharmrep.com
• Transitions help you sell because they give you a
  chance to "slip in" a benefit. Suppose you start
  off by talking about the efficacy of Drug A. At
  the end of the first section, you can say "It not
  only has greater efficacy, but because patients
  only have to take it once a day, this translates
  into greater compliance."
• Where are all the resources for doctors to
  realize that they are just trying to sell?

41
Doctors

• I have personally witnessed a Dr perscribe a drug
  simply for the reason that the rep bought them
  lunch that day
• They did not consider price
• They did not consider indication
• They did not even consider if this was actually
  the drug they needed
• So the Reps are doing there job right, are the
  doctors doing theirs?

42
Doctors

• The CAGE Questionnaire for Drug Company
  Dependence
• Have you ever prescribed CelebrexTM?
• Do you get Annoyed by people who complain about
  drug lunches and free gifts?
• Is there a medication loGo on the pen you're
  using right now?
• Do you drink your morning Eye-opener out of a
  LipitorTM coffee mug?
• If you answered yes to 2 or more of the above,
  you may be drug company dependent.

43
Doctors

• Are gifts from pharmaceutical companies ethically
  problematic? A survey of physicians
• Survey of 42 residents and 52 faculty at a
  university-based IM training program.
• 21 item questionnaire. 4 point Likert scale.
• 90 response rate (105/117 residents).
• 93 of residents, 73 faculty responded.

Arch Intern Med. 20031632213-2218
44
(No Transcript)
45
Doctors

• They concluded that physicians at a single
  institution tended to hold fairly lenient views
  on the ethical propriety of a wide range of gifts
  and activities sponsored by the pharmaceutical
  industry

46
Doctors

• Most residents who considered a promotion to be
  appropriate had accepted that gift or would have
  done so had it been available
• residents who considered a promotion
  inappropriate reported having accepted it
  nonetheless.
• Every resident who considered conference lunches
  and pens inappropriate had taken these items at
  least once.
• Similarly, half of those who felt
  industry-sponsored recreational events were
  inappropriate had either participated in such
  events or intended to do so.

Am J Med 2001110551
47
Doctors

• Most obtusely they found the following
• Most residents believed that interactions with
  pharmaceutical representatives have no impact on
  their own prescribing practices, whereas only 16
  believed that the prescribing behavior of other
  physicians is similarly unaffected
• But they will be those physician when they are
  done with their training.

48
There Long Reach

• Economy
• Government
• The Doctors
• The Journals
• The Public

49
Journals

• I have fallen victim to imfallabilizing journal
  articles
• Where do we go when we have questions on medical
  decisions?
• We do a article search, and we believe it will be
  objective and influece free
• However, the Pharm Cos influence spreads there
  as well

50
Journals

• From the British Paper The Observer
• Revealed how drug firms 'hoodwink' medical
  journals, Pharmaceutical giants hire ghostwriters
  to produce articles - then put doctors' names on
  them
• Estimates suggest that almost half of all
  articles published in journals are by
  ghostwriters.
• While doctors who have put their names to the
  papers can be paid handsomely for 'lending' their
  reputations, the ghostwriters remain hidden.

Sunday December 7, 2003 The Observer
51
Journals

• In February the New England Journal of Medicine
  was forced to retract an article published last
  year by doctors from Imperial College in London
  and the National Heart Institute on treating a
  type of heart problem
• It emerged that several of the listed authors had
  little or nothing to do with the research.
• The deception was revealed only when German
  cardiologist Dr Hubert Seggewiss, one of the
  eight listed authors, called the editor of the
  journal to say he had never seen any version of
  the paper.

52
Journals

• An article published in the Journal of Alimentary
  Pharmacology involved a medical writer working
  for drug giant AstraZeneca - a fact that was not
  revealed by the author.
• The article acknowledged the 'contribution' of Dr
  Madeline Frame, but did not admit that she was a
  senior medical writer for AstraZeneca.
• The article essentially supported the use of a
  drug called Omeprazole - which is manufactured by
  AstraZeneca - despite suggestions that it gave
  rise to more adverse reactions than similar
  drugs.

53
Journals

• A letter written to BMJ by whistle blower Susanna
  Rees an editorial assistant with a medical
  writing agency until 2002
• Medical writing agencies go to great lengths to
  disguise the fact that the papers they ghostwrite
  and submit to journals
• 'There is a relatively high success rate for
  ghostwritten submissions
• She goes on to say that part of her job had been
  to ensure that any article that was submitted
  electronically would give no clues as to the
  origin of the research.

British Medical Journal Website Published Letters
54
Journals

• 'One standard procedure I have used states that
  before a paper is submitted to a journal
  electronically or on disc, the editorial
  assistant must open the file properties of the
  Word document manuscript and remove the names of
  the medical writing agency or agency ghostwriter
  or pharmaceutical company and replace these with
  the name and institution of the person who has
  been invited by the pharmaceutical drug company
  to be named as lead author, but who may have had
  no actual input into the paper

55
Journals

• A recognised doctor will then be found to put
  his or her name to it and it will be submitted to
  a journal without anybody knowing that a
  ghostwriter or a drug company is behind it.

56
Journals

• The observer journalist also unconvered that Dr
  David Healy, of the University of Wales, was
  doing research on the possible dangers of
  anti-depressants, when a drug manufacturer's
  representative emailed him with an offer of help.
  
• The email, seen by The Observer, said 'In order
  to reduce your workload to a minimum, we have had
  our ghostwriter produce a first draft based on
  your published work. I attach it here.
• The article was a 12-page review paper ready to
  be presented at an forthcoming conference.
• Healy's name appeared as the sole author, even
  though he had never seen a single word of it
  before

57
Journals

• But he was unhappy with the glowing review of
  the drug in question, so he suggested some
  changes.
• The company replied, saying he had missed some
  'commercially important' points.
• the ghostwritten paper appeared at the conference
  and in a psychiatric journal in its original form
  - under another doctor's name

58
Journals

• Healy went on to say to the observers reporter
• the evidence I have seen would suggest there are
  grounds to think a significant proportion of the
  articles in journals such as the New England
  Journal of Medicine, the British Medical Journal
  and the Lancet may be written with help from
  medical writing agencies,
• They are no more than infomercials paid for by
  drug firms.

59
Journals

• In the United States a legal case brought against
  drug firm Pfizer turned up internal company
  documents showing that it employed a New York
  medical writing agency.
• One document analyses articles about the
  anti-depressant Zoloft.
• The articles with no doctors name on it had in
  the margin the initials TBD, which Healy assumes
  means 'to be determined'.

60
Journals

• Even Dr Richard Smith, editor of the British
  Journal of Medicine, admitted ghostwriting was a
  'very big problem
• Smith went on to say The articles come in with
  doctors' names on them and we often find some of
  them have little or no idea about what they have
  written
• 'When we find out, we reject the paper, but it
  is very difficult

61
Journals

• In another letter published by the editor of BMJ,
  Dr. Smith entitled Medical journals and
  pharmaceutical companies uneasy bedfellows
• In doing their best for patients, doctors will
  need to use the products the pharmaceutical
  industry makes, and it's reasonable that the
  industry should be able to promote its products.
  
• But surely doctors should be looking also to
  independent sources of information

BMJ  20033261202-1205 
62
Journals

• how did we reach a point where so many doctors
  won't attend an educational meeting unless it's
  accompanied by free food and a bag of "goodies"?
• Something's wrong, and medical journals are part
  of what's wrong.

63
Journals

• When the editor of a respectable journal admits
  that journals are now a problem how do we
  continue the persuit of EBM?
• Very effectively the Cos have deceived
  physicians believing they are doing what is best
  for their patient.

64
Journals

• Ok, so what about the dr who really care?
• In a case last year, researchers at the
  University of California at San Francisco defied
  a corporate sponsor by publishing a study
  concluding that Remune, a vaccine-like product
  developed as an HIV therapy, did not benefit
  patients who were already receiving standard
  treatments.
• The company, Immune Response Corp. of Carlsbad,
  Calif., is seeking 7 million to 10 million in
  compensatory damages from the university for
  harming its business.

Washington Post August 5, 2001
65
Journals

• University of Toronto physician Nancy Olivieri
  lost her research contract with Apotex Inc., a
  Canadian drug company, after she spoke out and
  published an article in 1998 about a serious side
  effect of deferiprone, a drug for a blood
  disorder.
• In the early 1990s, UCSF pharmacologist Betty J.
  Dong found that cheaper generic versions of
  thyroid hormone worked as well as Synthroid, the
  brand-name drug whose maker had funded the
  research.

66
Journals

• The company, Knoll Pharmaceuticals, successfully
  blocked publication of Dong's findings for seven
  years.
• In 1999, Knoll agreed to pay 37 states almost 42
  million to settle a suit alleging that it had
  made false claims that Synthroid was superior to
  competing brands and had interfered with the
  publication of the study.

67
Journals

• So even when a physician tries to do the right
  thing, the pharm cos do absolutely everything
  with in their power to either stop, alter or
  eliminate the facts that would alter profits
• So now, how do we know what we are reading is not
  a ghost written?

68
Journals

• The New England Journal of Medicine, the Lancet,
  the Annals of Internal Medicine and the Journal
  of the American Medical Association (JAMA) are
  among the journals that have agreed to publish a
  joint editorial in mid-September outlining the
  new policy, which was drafted by a committee of
  editors over the last several months.
• The unprecedented move could have a significant
  impact on how medical research is conducted and
  reported by giving researchers more leverage in
  their dealings with the pharmaceutical industry.

69
Journals

• Editors said the new policy is a response to
  companies' increasingly tight hold over how
  research is done
• in many cases, over whether and how the results
  are made public

70
There Long Reach

• Economy
• Government
• The Doctors
• The Journals
• The Public

71
The Public

• The number one person they need is the public.
• They buy their drugs
• Their wallet fills their pockets

72
The Public

• Pharm Cos filter everything the public sees
• A professor asked Bayer for a supply of Cipro to
  conduct a study and this is what they sent him to
  sign
• We declare that we will inform Bayer AG in
  writing of our test results and will not publish
  or commercialize them without written permission
  of Bayer AG

Lancet April 14, 2001 3579263
73
The Public

• The Lancet recently came under pressure to remove
  a sentence from the discussion of a research
  paper, which raised questions over the safety of
  a drug.
• The lead author had shown the report to the
  company after final journal pages were passed for
  publication.
• The best way for the journal to support her was
  to promise to publish an editorial naming the
  company and describing its attempts to manipulate
  the study's conclusions, if the offending
  sentence was removed.
• In the end thanks to the editors promise to
  publish the editorial, the report remained
  unchanged

74
The Public

• Most of the organizations that are supposed to be
  independent resources for the public are in the
  cos pay roll
• The National Alliance for the Mentally Ill (NAMI)
  bills itself as "a grassroots organization of
  individuals with brain disorders and their family
  members.
• NAMI is widely viewed as an independent advocate
  for the mentally ill, and an influential voice in
  mental health debates

Nov/Dec Issue of Mother Jones News Magazine
75
The Public

• According to internal documents obtained by
  Mother Jones, 18 drug firms gave NAMI a total of
  11.72 million between 1996 and mid-1999.
• Janssen (2.08 million)
• Novartis (1.87 million)
• Pfizer (1.3 million)
• Abbott Laboratories (1.24 million)
• Wyeth-Ayerst Pharmaceuticals (658,000)
• Bristol-Myers Squibb (613,505)
• The top contributor made Prozac, which is a huge
  mentally ill used drug

76
The Public

• "They appear to be a completely independent
  organization, but they parrot the line of the
  drug companies in saying that drugs are the
  essential thing."
• NAMI's approach "reduces human distress to a
  brain disease, and recovery to taking a pill,"
  says Sally Zinman of the California Network of
  Mental Health Clients.
• "Their focus on drugs obscures issues such as
  housing and income support, vocational training,
  rehabilitation, and empowerment, all of which
  play a role in recovery."

77
The Public

• 2001 DATA SHOW BIG DRUG COMPANIES SPENT ALMOST
  TWO-AND-ONE-HALF TIMES AS MUCH ON MARKETING,
  ADVERTISING, AND ADMINISTRATION AS THEY SPENT ON
  RESEARCH AND DEVELOPMENT
• spent a total of 45.4 billion on marketing,
  advertising, and administration and only 19.1
  billion on RD last year
• Since 1995, RD staff of U.S. brand name drug
  companies have decreased by 2, while marketing
  staff have increased by 59.
• Currently, 22 of staff are employed in research
  and development, while 39 are in marketing

Families USA (non profit health care organization)
78
The Public

• They invest more of their money in marketing the
  public than developing drugs
• Try to turn on a radio or TV with out seeing a
  Drug add

79
The Public

• Last July, Schering-Plough became the first
  pharmaceutical company to use a celebrity in a
  direct-to-consumer national television campaign.
  
• It tapped Lunden, former Good Morning America
  anchor, to promote its prescription allergy pill,
  Claritin.
• The aggressive advertising campaign for Claritin
  helped worldwide sales soar by 35 percent last
  year to 2.3 billion, including 1.9 billion in
  U.S. sales

Houston Chronicle Mar 7, 1999
80
The Public

• Drug companies use different types of celebrity
  pitches to sell their products. In some
  instances, they use those who can give a
  firsthand testimonial to the effectiveness of the
  drug, as Lunden did with her hay fever treatment
• But they get even more creative to reach the
  public
• Schering-Plough advertises Claritin on United
  Airlines baggage tags
• Merck offers patients a money-back guarantee on
  its cholesterol-lowering drug, Zocor

81
The Public

• They even create disease states
• Pfizer, maker of Viagra - the only pill available
  in the United States for treatment of impotence -
  launched an educational campaign on the disorder
  last month featuring former Senate Majority
  Leader Dole.
• Now Erectile Dysfunction is a household term
  and every one has it
• AND THEY WANT THEIR PILLS!!!

82
The Public

• In 2000, Merck spent 161 million on advertising
  for Vioxx.
• That is more than Pepsico spent advertising
  Pepsi. (125 million), and more than
  Anheuser-Busch spent advertising Budweiser.(146
  million).

National Institute for Health Care
ManagementResearch and Educational Foundation
83
The Public

• April 16, 2001, the U.S. Food and Drug
  Administration (FDA) had approved the
  antidepressant Paxil, made by British
  pharmaceutical giant GlaxoSmithKline, for the
  treatment of generalized anxiety disorder
• But GAD was a little-known ailment according to
  a 1989 study, as few as 1.2 percent of the
  population merited the diagnosis in any given
  year
• If GlaxoSmithKline hoped to capitalize on Paxil's
  new indication, it would have to raise GAD's
  profile.

Mother Jones Magazine july/august issue
84
The Public

• On April 16--the date of Paxil's approval--a
  patient group called Freedom From Fear released a
  telephone survey according to which "people with
  GAD spend nearly 40 hours per week, or a
  full-time job,' worrying."
• Local newscasts around the country reported that
  as many as 10 million Americans suffered from an
  unrecognized disease.
• Viewers were urged to watch for the symptoms
  restlessness, fatigue, irritability, muscle
  tension, nausea, diarrhea, and sweating, among
  others

85
The Public

• Many of the segments featured sound bites from
  Sonja Burkett, a patient who'd finally received
  treatment after two years trapped at home by the
  illness, and from Dr. Jack Gorman, an esteemed
  psychiatrist at Columbia University.
• Their testimonials were intercut with peaceful
  images of a woman playing with a bird, and
  another woman taking pills.

86
The Public

• Now their tactic is getting FDA indication for
  diseases
• Originally approved solely as antidepressants,
  the SSRIs are now prescribed for a wide array of
  heretofore obscure afflictions--GAD, social
  anxiety disorder, premenstrual dysphoric disorder
• The proliferation of diagnoses has contributed to
  a dramatic rise in antidepressant sales, which
  increased eightfold between 1990 and 2000

87
The Public

• For pharmaceutical companies, marketing existing
  drugs for new uses makes perfect sense
• A new indication can be obtained in less than 18
  months, compared to the eight years it takes to
  bring a drug from the lab to the pharmacy
• Once they get the indication, nauseate the public
  with adds in repetition of the signs and symptoms
  so when they go to the Docs office, they are not
  asking, but demanding for the pill they saw on
  TV

88
The Public

• Try telling the patient that comes into your
  office seeking a pill they need that they dont
  need it
• In most cases the Dr doesnt have time to explain
  why
• And they will just go to someone else who will
  just fill the script
• Very effective marketing strategy

89
Conclusion

• So I hope from now on we will all think twice
  before we swallow the pill of information we
  get
• I hope we will at least scrutinize studies
  objectively
• Realize that if we perscribe the way they want,
  in the end we are just puppets

90
THE END
91
The Public