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DRUG COMPANIES CO-OPT
DOCTORS AS PART OF MARKETING BLITZ
By Mark Gruenberg
PAI Staff Writer
WASHINGTON (PAI)--The world’s big
drug companies, unfettered by any type of price restraints in their biggest
market--the U.S.--add to their huge profits by spending approximately one-third
of their revenues on marketing, including marketing that co-opts doctors, a
researcher on the issue says.
And consumers pay the costs of
this heavy advertising and marketing blitz, adds Marcia Angell. The marketing
includes everything from company-paid studies of drugs to underwriting medical
conferences to “free samples” which get doctors and patients to use new and
more-expensive, but not necessarily more-effective, medications.
Angell, former editor of the
prestigious New England Journal of Medicine, detailed the drug firm
tactics in a Sept. 15 talk sponsored by the AFL-CIO Department for Professional
Employees. Angell, an M.D., recently published her results in The Truth
About The Drug Companies: How They Deceive Us And What To Do About It.
Angell pointed out the nine big
drug companies are the most profitable group of firms in the Fortune 500. Their
median profit margin is 16 percent-17 percent of sales. That’s triple the
median profit margin for all firms in the list of the world’s largest
corporations. Most drug company profits come from the U.S., which has the
largest--and uncontrolled--market, she added. Canada and Europe control drug
The firms also spend twice as much
money on marketing and advertising as they do on research and development,
counteracting their own claims they need high U.S. drug prices to justify
expensive costs for R&D of new medications.
Further, she noted, many of those
“new” medications are so-called “me-too” drugs. Those are slight variations on
existing drugs, changed just enough to grab new patents and exclusive rights
just as old patents on predecessor medications are about to expire, putting
those older drugs on the market at much lower costs to consumers.
Other “new” medications, she
noted, are really developed by the government or by universities, which then
sell licensing rights to the big pharmaceutical companies. And the companies
also co-opt doctors, while their record spending on lobbying buys Congress, she
unintentionally--have become captives of the companies, Angell said. The firms
influence M.D.s in several ways:
* Sponsoring doctors’ research and
clinical trials of drugs. Negative findings, or findings that the new drugs are
no better than the old, are deep-sixed. The federal Food and Drug
Administration, which licenses drugs, does not require reports from failed
clinical trials. The drug companies also pay FDA fees for agency evaluations.
* Companies give doctors “free
samples” and the doctors then give them to patients. Since the samples are of
newer, more expensive drugs, “both the patient and the doctor are hooked” by the
patient’s reaction to the medication, she points out.
* Drug companies also launch
millions of dollars in direct-to-consumer advertising to convince the public it
needs drugs even for “illnesses they don’t know they have.” Such campaigns
increase money in company coffers as consumers ask doctors for unneeded
prescriptions for such ills as excess stomach acid, she notes.
“Their PR is extremely slick, so
education is the first thing” consumers can do to protect themselves, Angell
* The companies set a record in
2004 for the amount of money spent by one industry lobbying Congress and hired
more lobbyists in Washington than there are senators and representatives
combined. As a result of that--and loads of campaign contributions and the
industry’s own spending on advertising--Congress “is in the back pocket” of the
industry, Angell said.
That was most obvious in passage
of GOP President George W. Bush’s “Medicare Rx” law in 2004. The law bans
Medicare--the largest single buyer of medicines, with more than 40 percent of
all purchases--from negotiating with the companies for the lowest prices and
best available drugs. That gave companies a license to charge Medicare--and
taxpayers--whatever they please.
To combat the companies, Angell
said consumers should educate themselves and refuse to accept doctors’ words, or
free samples. “Ask ‘Is there a generic drug?’ That’s because generics are
cheaper than prescription medications. If the doctor says ‘no,’ ask if there is
“an older, cheaper, drug for the same condition,” she adds.
“If he says ‘no,’ again and adds
that a newer drug is better than an older one for the same condition, ask: ‘How
do you know? What’s the study of this?” Given that drug companies fund medical
studies, you also might want to ask who paid for the study of comparative
effectiveness of the older and newer drugs that your doctor cites. And if he
still resists giving you an answer, go to another doctor.”
Angell also suggested lobbying
lawmakers to let Medicare negotiate the lowest
prices and lobby FDA to change its prescription drug
rules. The only thing that could make lawmakers stand up to the companies and
their campaign contributions is if they feared retribution at the ballot box
from outraged consumers, Angell notes.
Angell said consumers should lobby
FDA to get it to require comparative testing of a new drug’s effectiveness
versus an older drug, and not a placebo, which is a sugar pill. Comparing
placebos with new drugs gives the companies an incentive to develop the “me-too”
drugs that really aren’t much better, if at all, than the older cheaper
medications they replace, Angell says. If the companies suddenly had to do
comparative studies, the “me-too” drugs would dry up, she contends.