The practice of medicine is a profession, and pharmaceutical marketing is a business. Physicians and hospitals have their obligations to patients, while drug companies put their allegiance toward public shareholders and private corporate owners. Simply stated, the interests of medicine and the pharmaceutical industry are not aligned – despite the fact that they ultimately have the same customer base.
According to Consumer Reports, nearly half (46 percent) of American adults take prescription drugs, the average adult taking four prescriptions regularly. Twenty-five percent of these people, ages 18 to 39, take two medications regularly.
There can be no denying that in many cases, pharmaceutical drugs have extended the quantity and quality of life. Generalized examples are Penicillin, Insulin, Ether, Diuretics, and Viagra. Individual medications such as Advair® for asthma, Gleevec® for chronic myeloid leukemia, and Remicade® for rheumatoid arthritis and Crohn’s disease have definitively been shown to be life-changing.
For many years, the drug industry operated in a reactive fashion. People developed diseases, researchers studied the conditions, scientists developed the drugs for treatment, and drug manufacturers marketed the drugs to the physicians and hospitals that would then distribute them to patients.
Today’s pharmaceutical companies participate in an industry that is riskier than ever. First off, just one out of ten-thousand or .01% of all created drug compounds is ever approved from the Food & Drug Administration. Only 15% of those approved will ever cover just the developmental costs, usually over a seven to ten year period. So, drug companies either need “blockbuster” creations to find more customers for existing products or……create new diseases out of thin air.
About 20 years ago, Lynn Payer, a health-science writer, coined the term “disease mongering”. She defined the practice as “trying to convince essentially well people that they are sick or slightly sick people that they are very ill”. This comes from Payer’s book Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick.
Other authors and researchers, such as Ray Moynihan, have dubbed this Big Pharma strategy as “the corporate construction of disease”. The strategy works especially well in the United States, as it is only one of two countries in the entire world that allows for the marketing of prescription drugs directly to consumers.
Several of the more popular strategies employed by drug companies, as told by Payer and others, include:
Drug companies file for and receive patents on their compounds for a 20-year period, giving them a monopolistic advantage against other players in the market. But once that patent is expired, generic medications (copies) quickly flood the market and the benefit is lost. This can cost drug companies billions in potential revenue each year.
According to Dr. Adriane Fugh-Berman, associate professor of pharmacology and director of the industry watchdog group PharmedOut.org at Georgetown University School of Medicine, a perfect example of inventing a disease is/has been demonstrated by Eli Lilly.
In 1999, the drug giant stood to lose a lot of profit when the patent for its prized-drug Prozac® was going to expire. They knew that Premenstrual Dysphoric Disorder (PMDD) had been proposed but not approved as a real disorder in the guidelines for psychiatric disorders.
Symptoms include the normally accepted gamut of symptoms such as:
- mood swings
- marked irritability or anger
- feelings of hopelessness
- marked anxiety
- decreased interest in usual activities
- difficulty concentrating
- change in appetite
- breast tenderness
For years, gynecologists have classified these feelings and symptoms as normal and common prior to a woman’s menstrual cycle. But in this case, Eli Lilly put massive amounts of funding, studies, and surveys to conclude that it was actually not normal, but a condition known as PMDD.
Naturally, Eli Lilly was looking out for the best interests of those suffering women. Although psychiatric organizations would not recognize it as a real disorder, the Food and Drug Administration did. In doing so, they allowed Eli Lilly to rebrand and recolor its Prozac pills as Sarafem®, thus extending its patent life for the treatment of PMDD.
We now have psychotropic anti-depressant medication for pre-menstrual symptoms. Well, that’s innovation and looking out for the betterment of women across the world. Now women can have a legitimate reason for missing work or school during their ‘PMDD days’.
Eli Lilly ran advertisements directly to consumers on TV and in women’s magazines relating to Sarafem. One such ad featured an ordinary-looking woman angrily trying to pull a grocery cart from a row. The tag line read: “Think it’s PMS? Think again … It could be PMDD.” Wow, what’s next…going postal?
Within two years, Eli Lilly sold Sarafem for $259 million. Once several of the other anti-depressant kingpins such as Zoloft® and Paxil® got into the PMDD game, Eli Lilly wasn’t the only game in town.
Taking common behavior and making it sound like it’s a sign of a serious disease
According to popular author Dr. Andrew Weil, a common tactic in the disease-mongering arsenal is to attach polysyllabic, clinical-sounding names to what used to be seen as normally short-lived conditions. In most cases, the new, formidable names come complete with acronyms, which add even more gravitas. Thus:
- Occasional heartburn becomes “Gastro-Esophageal Reflux Disease” or GERD.
- Impotence becomes “Erectile Dysfunction” or ED.
- Premenstrual tension becomes “Premenstrual Dysphoric Disorder” or PMDD.
- Shyness becomes “social anxiety disorder” or SAD.
- Fidgeting legs becomes “restless leg syndrome” or RLS.
While it is true that extreme variations of such conditions may require pharmaceutical treatment, Big Pharma does very little to draw distinction between serious and mild manifestations. Thus, a shift in leverage for the average individual’s understanding is slated in favor of the drug industry.
When someone has a small amount of gastric upset following a spicy meal, it is labeled “GERD,” and nervousness before giving a speech is “SAD.” And, of course, the drug industry is there to help by using existing drugs meant for other conditions to now be available for these common, yet uncomfortable conditions many people have. The more ‘many’ there are, the more profit can be had.
Promoting fear of death as a means to sell drugs
In 2003, Pfizer ran an advertising campaign in France and Canada for their statin medication Lipitor®. Their print advertisements, such as the one shown below, were supported by the Canadian Lipid Nurse Network and the Canadian Diabetes Association.
The point of this advertisement, along with a television counterpart, was to get people to have their cholesterol checked and treated (with Lipitor), or else face the very real possibility of death.
Did Pfizer ever make financial contributions to these supporting organizations? One surely must assume that they lent support to this type of marketing because it was for the betterment of individuals and not for any quid pro quo relationship (sarcasm mine).
And guess what else? Studies back then and today DO NOT support the conclusion that if you don’t take statins, you are at a high risk of cardiovascular events and hence death.
In a recent study in the British Medical Journal, Julia Hippisley-Cox, professor of clinical epidemiology and general practice, and Carol Coupland, associate professor in medical statistics examined data from over two million patients, including over 225,000 patients who were new statin drug users.
They found that for every 10,000 women being treated with statins, there were only 271 fewer cases of heart disease. Moreover, the statin drugs caused 74 cases of liver damage, 23 cases of acute kidney failure, 39 cases of extreme muscle weakness and 307 cases of cataracts. Ergo, statin drugs helped 271 people but harmed 443 people.
In 2012, the medical journal Atherosclerosis showed that statin use is associated with a 52 percent increased prevalence and extent of calcified coronary plaque compared to non-users. None of the participants in the study – 6,673 in all – had any known coronary artery disease at the time. In other words, using statin drugs increased ‘artery clogging and stiffening’, which is a hallmark of cardiovascular disease in itself.
What’s just as bad, drug companies have pushed the envelope in developing many different ‘Pre-Conditions’. Numbers that used to be normal for blood pressure, diabetes, and cholesterol have all been lowered due to the collusion between pharmaceutical companies and support from physicians. Would it surprise you that such relationships typically involve some type of monetary compensation for opinion?
Do you know people who fall into this new high range of normal? They are now classified as those having pre-hypertension, pre-diabetes and borderline high cholesterol. Guess what this means? You got it – they qualify for being on medication.
Stopping Big Pharma from disease mongering won’t be easy. They are funding their efforts with tremendous amounts of money, as well as with political and professional interests. This process is disempowering all-too trusting citizens by tapping into our fear of suffering and death, as well as manipulating the Food and Drug Administration and those who can legally deliver their products to the masses. Here are three tactics I recommend:
Create a Law for Clear Disclosure
One tactic I would use would be to put into law a process similar to that on Wall Street, where financial analysts who recommend stocks, bonds, and mutual funds MUST disclose if they have a position in such a company.
Physicians, medical organizations, universities, non-profit charities, etc. would all need to disclose in their research or news articles that they either did or did not have a relationship with the product or drug company they were writing about or recommending, despite whether the research was positive or not.
This disclosure would need to be in big bold letters at the top of every article. Transparency goes a long way in leveling the playing field of information and decision-making. It also re-establishes lost trust.
Simplifying Results For Easy Reading
Today, the FDA requires that every study done by a pharmaceutical organization on their drug(s) must be made public. That’s fine, except that most ordinary people don’t understand how to read these studies, nor do they want to take the time. People assume that if studies are done by reputable institutions, they must have the best interests of suffering patients at the top of the list.
People want and need this type of information to make informed choices, but it needs to be simplified to perhaps an eighth grade reading level. These studies are not just for patients and interested individuals, but also physicians.
Patients truly believe that their physicians take the time to read the latest articles on medications and then weigh the pros and cons to make a responsible and well-thought-out decision on determining use. In many cases, doctors themselves rely on pharmaceutical salespeople to shorten their learning curve through short lunches and strategically-designed product literature.
Pharmaceutical Report Card
When all the studies are done, the articles are written, the promises realized and the complaints filed, I’d like to see the Food and Drug Administration grow a set of elephant-sized testicles and step up to provide an overall current grade to each drug on the market. A lot of parameters would go into this grading, including perhaps all past and current scientific studies. These would be broken down to positive and negative results. Another parameter, for example, would be filed complaints and successfully-settled lawsuits.
In the end, such a report card format could provide updated, validated data from a trusted non-pharmaceutical resource, so that people and physicians could determine a medication’s effectiveness and safety.