If you’ve been reading this series, you already have an inkling that your health, your most precious possession, is being compromised by tacit collusion among the pharmaceutical industry, government, medical profession, and health insurance industry. Most prescription medications are prescribed unnecessarily, and you have the power to stop, or avoid altogether, some of the most heavily marketed drugs. Let’s begin with the pharmaceutical industry, or Big Pharma, those ten multi-national giants with names like Pfizer, Searle, Eli Lilly, Merck, and Abbott, whose jaw-dropping mega-profits allow their CEOs to earn an average salary of $50 million a year and hold another $100 million in unexercised stock options.
Like any enterprise out to please its shareholders, the business of a pharmaceutical company is to sell its product–drugs–for the highest possible profit. Because the money to be made is so vast, the industry has a created a stranglehold on American medicine, regularly acting in ways that are patently illegal and then paying the government fines for doing so, chalking up the expense as part of the cost of doing business. Even the insurance companies can’t figure a way to hold them back.
Two examples of this: Flint Pharmaceuticals, makers of Synthroid, spread the rumor (not based on any facts) that their synthetic thyroid replacement was safer and more reliable than the old standby Armour thyroid. Long after their patent on Synthroid had expired and Flint had made its billions, the FDA levied a rap-on-the-knuckles fine for this misinformation. The makers of Neurontin were fined several years ago for encouraging its drug reps to tell doctors their product helped fibromyalgia (it did not). Get the gist?
Here are a few commonly used tactics:
• Big Pharma generally buys the distribution rights for a drug from a smaller company and then shares the royalties with the smaller company. Obviously there’s nothing wrong with this, except the almost obscene profit margin on someone else’s patent is spun by the industry’s PR machine, which conveys an atmosphere of painstaking discovery and research. Lyrica, for example, was developed at Northwestern University and the school is making a fortune in royalties from it. Viagra started at a UK company and Lexapro started in Europe. Doctors are never told that the prescription Namenda for Alzheimer’s is a gussied up version of an inexpensive over-the-counter nutritional supplement (galantamine), available online at a fraction of the price. The very expensive Omacor is the same fish oil you can buy without a prescription at a dramatically lower price. To further enhance their profits, actual drug manufacturing often takes place in any country where the labor is cheapest. The savings are never passed on to consumers.
• “Research” regarding drug development and safety is highly suspect. Physicians involved in research studies are paid a fortune and more often than not results are produced showing that a new drug is highly effective. I recently read an article in the journal Pain reporting a lengthy study of the virtues of Lyrica for fibromyalgia. Virtually every one of the researchers, reviewers, staff, and even the writer of the article itself acknowledged receiving a paycheck from the drug’s manufacturer, Pfizer. Not long ago it was revealed that the research articles published in medical journals are frequently ghostwritten by professional writers contracted by the drug companies and that physician “researchers” simply sign off on the final version. The medical journals publishing these articles were once highly reliable and subscriptions to them very expensive. Now they’re virtually all free to doctors, I assume because drug companies are underwriting most of the publishing costs. In February, 2003, the New England Journal of Medicine had to retract a journal report from the Imperial College in London and the National Heart Institute on a certain heart treatment when it was revealed that some of the physicians named as authors had had nothing to do with it. There are dozens more examples.
• Often, Big Pharma simply copies someone else’s successful drug. For example, there are about twenty NSAIDs (non-steroidal anti-inflammatory drugs, such as Advil, Lodine, Naprosyn, and Meclomen), not one any better than aspirin. There are six cholesterol-lowering drugs, eight migraine meds, and an equal number of ACE inhibitor blood pressure drugs. By tacit agreement among the companies that make up Big Pharma, the price of all the drugs in each class is the same–high.
• Big Pharma is the largest single lobbying group in Washington. Nothing compares to its power. When Medicare Part D (drug coverage) was being created and someone suggested competitive pricing, the lobby literally bought a few Congressmen and pushed a bill through that even the AMA and AARP felt was just short of thievery.
• Pharmaceutical companies use several extremely devious tricks to prevent their drugs from going generic, which kills their cash cow and makes the drug far less expensive for you, the consumer. Some companies simply buy their competitor. Pfizer got a patent extension for Lipitor by acquiring the Indian company that was going to make the generic version of this cholesterol drug. Forest Labs just bought Armour thyroid, maker of thyroid replacement hormones, and I expect the price of this worthy drug will go from pennies to dollars. Other companies hawk a new size. When the muscle relaxant Flexeril 10 mg went generic, the patent owner then patented a 5-mg tablet and promoted it as the “better” choice. Another muscle relaxant, Soma, went generic at 350 mg and suddenly there was the new, improved Soma 250 mg. Other companies obtain patent extensions by requesting new FDA approval for a slightly different, but essentially identical, drug. Prozac (now generic) works for PMS and thus was renamed Sarafem (brand name and therefore expensive). Still others return to the laboratory to jiggle a molecule ever so slightly in order to produce a “new” drug that will keep the cash cow producing. The ADD medicine Adderall XR is about to go generic, so out comes Vyvanse. The antidepressant Effexor XR is being phased out for the “new” Pristiq. Interestingly, one of the best watchdogs here is the State of Illinois Medicaid system, which is on to this game and rarely allows new “patent extender” drugs onto their formulary–the list of prescription medications they will pay for.
• The Food and Drug Administration (FDA) was originally created to protect the consumer. The FDA is now so completely in the pocket of the pharmaceutical industry that many FDA employees are depressed and demoralized. “Rubber stamp approval” of new and inadequately tested drugs is common. When significant side effects start appearing a year later, it can take years of legal maneuvering before a drug is actually withdrawn or a special black-box warning is added to the drug’s label. Remember, every year roughly 120,000 people die from correctly taken prescription drugs.
•If you want to read more about the current hand-in-glove status of the FDA and pharmaceutical companies, take a look at Comfortably Numb, by Charles Barber.
Next time: How doctors and medical schools are compromised by Big Pharma.
David Edelberg, MD