Hypnotized by Big Pharma

Virtually every day, a fax arrives asking me to participate in one market research study or another on some medical issue related to Big Pharma. If I happen to be interested, I call a phone number, am asked a few questions to determine if I qualify (they especially like primary care doctors), and am scheduled for an appointment. Sometimes I arrive and there’s a group of doctors, sometimes it’s a one-on-one.

I ignore 99% of these come-ons, but last week one caught my eye: $300 for one hour of my opinion on osteopenia, an early form of osteoporosis that’s easily helped by lifestyle changes and some good nutritional supplements. The location was a short bike ride from my office and, like most reasonable people, $300 falling into my lap for an opinion (something I’m never at a loss for) is nothing to sneeze at. There would be no product sales during the interview. There never are–it’s not a sales pitch.

This one-on-one interview was weird from the start. “I want you to close your eyes and relax,” began the pleasant young woman typing furiously into her laptop. “Tell me about the moment you first decided to become a doctor. Describe the moment. Describe the scene.”

“Well,” I thought, “It’s her dime.” I came up with juicy piece of narrative, probably something I’d seen on TV. I couldn’t really explain that pre-1960s Jewish families decided the occupation of their sons at birth. I was never not going to be a doctor. At age three, my grandmother greeted me with “Here’s little Dr. Edelberg.”

She continued, “Now recreate for me a scene that’s totally relaxing for you.” This was easy. Hammocks, warm summer afternoons, cold pinot grigio. “And when you decided to become an internist.” Now things were getting a bit boring.

Then came the big question, the juice behind the pending three hundred smackers. “Can you describe for me the last time you saw a patient with osteopenia? How did you feel? What did you tell her?”

I explained (with my eyes now open and blinking as my contacts had uncomfortably dried out) that since osteopenia is a lab test result and doesn’t cause any symptoms, patients don’t come in saying, “My osteopenia is acting up.” If a patient mentions it at all, it’s because of a bone density test result, which she pulls from her purse along with a prescription for a medication (from the Fosamax family) that she’s worried about taking because she’s read about the side effects.

My patient has pondered a perfectly reasonable question: Should I take, for the rest of my life, a very expensive drug–for essentially an abnormal lab test–whose side effects include ulcers on my esophagus and jaw disease with loose teeth, and which might increase my chances of a hip fracture?

“And what do you tell her, Dr. Edelberg?”

“I say that the med is generally unnecessary, that with weight-bearing exercises, a healthful diet, and a good bone building supplement, she can probably hold her osteopenia at bay. I think the drugs are highly toxic and use them only as a last resort.”

“And how do you feel emotionally when you help her with her osteopenia?” (I swear she asked me that question).

“They say that in Heaven an angel gets its wings if a doctor can keep a patient from taking a toxic medication.” (I thought that a better answer than, “Pretty good. Yeah, I feel pretty good.”) I doubt if she got the movie reference but she typed it right into her laptop.

What Big Pharma can learn from this patently insane interview can mean hundreds of millions of dollars in their coffers. With a medication for osteopenia, the doctor is not treating a patient but rather a lab test result that may or may not lead to an actual medical condition (osteoporosis), which itself may or may not cause problems for the patient in the future. This is envisioned as a lifelong medication despite recent reports and an FDA warning that the quality of bone created by the drugs is not as good as normal bone.

Bone-building drugs have significant side effects and are very expensive. Fosamax, for example, is $1,400 a year. If a 50-year-old women is given a prescription and follows her doctor’s orders implicitly–something you should never do–she’ll generate roughly $35,000 in sales for the drug company. Serious money.

What Big Pharma wanted from this market research interview was to determine how motivated physicians are to treat what comes down to an abnormal lab test. If doctors seem motivated, then likely the company will begin sponsoring seminars on the “dangers” of osteopenia, and get an “expert panel” to issue a statement on how often bone density tests should be performed. (Expect their conclusion to be “often.”) They’ll hit the jackpot if they can get experts (highly paid) to change the cut-off point on what is now scanned as “normal bone” to “early osteopenia.” That happened with LDL (bad) cholesterol and netted billions in revenues. Later, it was revealed that many of the physicians involved in the decision had a financial interest in cholesterol-lowering meds.

Currently, the big prescribers of the osteoporosis drugs are gynecologists, who frequently order bone density tests along with mammograms, glance briefly at a blurry picture of a bone, read the word “osteopenia,” and write a quick prescription, thinking they’re practicing preventive medicine. Their professional journals are packed with ads for various osteoporosis drugs, each clamoring for the millisecond of attention that can etch their brand name into the doctor’s brain when the prescription is written.

Doctors virtually never recommend lifestyle changes except for “take some calcium” and most have never heard of Dr. Alan Gaby’s excellent book Preventing and Reversing Osteoporosis. Big Pharma has taken over their thinking.

I left with my $300, cycled home, and dutifully turned it over to my wife.

But for you, forewarned is forearmed.

Postscript: By an amazing coincidence, within a week of writing this piece there appeared a statement from the US Preventive Services Task Force regarding lowering the age for osteoporosis screening. Interestingly, perhaps because they were so embarrassed by the financial connections from their previous cholesterol recommendations, this time their statement is “open for comment” (whatever that means).

However, dealing with the shenanigans of Big Pharma is like the Whack-A-Mole game. Just when one shady trick is semi-controlled, up pops another. It seems the federal government is now investigating (and trying to make illegal) Big Pharma’s trick of paying off generic manufacturers not to manufacture and distribute inexpensive medications as they come off patent. What will they think of next?