Last week, a Congressional committee properly raked Big Pharma over the coals for misleading advertising of pharmaceuticals.
A
hearing of the House Energy and Commerce Committee's oversight subcommittee focused on advertising campaigns for three drugs, including the remarkable case of Robert Jarvik. Jarvik is featured in endlessly re-run ads for Pfizer's blockbuster cholesterol drug Lipitor. Known as the inventor of the Jarvik artificial heart, he is not a cardiologist, not a licensed medical doctor and not authorized to prescribe pharmaceuticals. He's shown in the ads engaged in vigorous rowing activity, but in fact he doesn't row. Pfizer pulled the ads in February after controversy started brewing.
Among industrialized countries, only the United States and
New Zealand permit drug companies to market directly to consumers. It's a bad idea, it drives bad medicine, and it
should be banned.
But although it has the highest profile, direct-to-consumer advertising is a small part of Pharma's marketing machine.
Researchers Marc-André Gagnon and Joel Lexchin conclude in a recent issue of the journal PLOS Medicine that direct-to-consumer ads make up less than a tenth of industry marketing expenditures ($4 billion of $57.5 billion in 2004). And Gagnon and Lexchin's estimate of $57.5 billion on marketing excludes many industry expenditures that are really driven by marketing, including clinical trials conducted for marketing purposes.
The bulk of the industry marketing effort -- more than 70 percent by Gagnon and Lexchin's calculation -- is directed at doctors.
Why?
Because it works.
The companies spend huge amounts
paying firms that carefully track what doctors prescribe, and then they use the information to tailor messages to doctors, distribute samples and develop continuing medical education programs.
Gagnon and Lexchin report that Pharma spends more than $20 billion a year on "detailers" -- the pharma reps that knock on doctor doors, ply the staff with free coffee and lunches, distribute samples ($16 billion worth), and prod docs to prescribe their drugs.
This is complemented by a host of tactics that in other circumstances might be called bribes.
"Virtually all physicians in America take cash or gifts from the drug companies," says Melody Petersen, author of
Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, and a former New York Times reporter. "A recent survey said 94 percent of physicians took something of value from the drug companies. Some doctors take hundreds of thousands of dollars a year from these companies, and there’s no law that says they can’t."
Petersen says she "had no idea this was so extensive until one day I was writing a story about Celebrex and Vioxx -- this was before Vioxx was taken off the market. The story was about the marketing battle between these two pain drugs. I called one of the large societies of rheumatologists and asked for an expert on arthritis. I specifically said I needed an expert who was not being paid as a consultant to one of the manufacturers of these drugs. A staff person said, 'We have lots of people you can talk to, but all of these doctors are consultants to one or both of the drug companies.'"
Drug companies hire doctors to give lectures, and they hire other doctors as "consultants" to go to fancy dinners and listen to the lectures. "There are more than 500,000 of these dinners or events in America every year," Petersen says.
The drug companies weave these diverse strategems into an elaborate tapestry -- not infrequently to push drugs for inappropriate purposes. One eye-opening case that Petersen details in Our Daily Meds concerns Neurontin, a mediocre drug for epilepsy that Warner-Lambert illegally peddled as an unapproved treatment for bipolar disorder, migraines, attention deficit disorder in children and other conditions. The drug does not work for most of these conditions. Many persons were injured by taking excessive doses of Neurontin, and many others wasted money and emotional energy on hopeless Neurontin treatment strategies. Warner-Lambert ultimately
paid $430 million to settle criminal and civil charges related to Neurontin marketing, but Petersen says that, even so, the illegal marketing scheme was clearly profitable for Warner-Lambert (and Pfizer, which acquired Warner-Lambert in 2000).
Petersen's account of the Neurontin nightmare draws heavily on a whistleblower, David Franklin. She summarizes the central theme of the story Franklin revealed: "The company got doctors to prescribe the drug for all these experimental uses by paying them. They paid physicians to give speeches to other physicians at restaurants or hotels or resorts. The doctors not only enjoyed a nice meal or a weekend vacation, they often also received a $500 check for attending. The physicians giving lectures at these parties were often trained by the drug company’s ad firm to describe how Neurontin could work for conditions like bipolar. … The company tracked the doctors’ prescriptions before and after these dinners or weekend retreats. The executives saw how well it worked."
Which raises an interesting question: How is that industry can so effectively manipulate highly trained doctors?
Answers Adriane Fugh-Berman, a doctor and Georgetown University professor who runs
PharmedOut, a project that focuses on how pharmaceutical companies
influence prescribing decisions and encourages physicians to educate themselves from non-industry sources: "Physicians are trained in medicine, not psychological manipulation. Every bit of flattery, friendship and information offered by reps is aimed at selling drugs."
There is no simple solution to these problems, though
ending patent-based marketing monopolies would transform pharmaceutical marketing practices and likely eliminate most abuses.
In the meantime, a ban on Pharma gifts to doctors would be a modest step forward. In the United States, notes Petersen, "radio disc jockeys can’t take cash from music companies. But when it comes to something like medicines -- which mean life or death for people -- doctors can take as much money as they want from the drug companies. We need a law to stop that."
Note: I serve as managing director for Commercial Alert, which advocates for elimination of direct-to-consumer pharmaceutical advertising.
We had fine wines, fancy desserts and entrees I'd only read about in upscale magazines. One "seminar" was marred, though, by a drug rep actually giving a Power-Point presentation on a new wonder drug before the entrees were served. I was glad to be a beneficiary of all that Big Pharma R&D money.
The other question that comes to mind for me: Do Insurance companies who pay so much of the Doctors' bills put pressure on Doctors to write prescriptions for certain brands of drugs?
A bit of a different slant on the topic but a piece you might enjoy nonetheless.
I too was in the medical field until my retirement and I can assure you that professionals can learn about new treatment options without a lavish dinner - in fact its their job to keep up.
Not long ago, usually on television, one viewing will often at times see an advertisement for some type of medication- usually it is a drug involved with the treatment in a large market disease state. Such commercials are sponsored by large pharmaceutical corporations for particular networks on television. This is called direct to consumer advertising, and both doctors and citizens largely prefer that they do not exist.
Since 1997, when the FDA relaxed regulations regarding this form of DTC advertising for the pharmaceutical industry, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry has spent around 5 billion annually on this media source. The industry ranks number two on their spending of media campaigns- next to automobiles, I believe. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns typically associated or possible with newer medications, as history has shown.
The purpose of DTC ads are not to educate and inform the viewers, in my opinion, as others have claimed. Any advertising of any type shares the same objective- which is to increase sales and grow their market for a particular product and, in this case, for a particular perceived medical condition or disease state that may or may not exist, as a television is not by definition a health care provider for the viewer.
The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment soon for what may be an unconfirmed medical condition or disease suggested with such DTC advertisements. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads before they are presented to the public, in relation to their accuracy and clarity, as well as possibly their effect on the health care system, as the FDA allows the DTC advertising to continue, yet now it is becoming more restricted, I understand.
DTC advertising is also a catalyst for and similar to disease mongering.
Disease mongering is the creation of what some believe should be medical flaws, and illustrated by the creators through exaggeration and embellishments through such media sources as an avenue for what appears to be propaganda often, as is often seen with DTC advertising. The content of the advertisements appear to be medically absent, yet realistically they are in fact corporate creations of these questionable human ailments that do not or may not require treatment, possibly, and may be attempts by the makers of certain drugs to develop or embellish a particular medical condition to acquire additional profit.
One of my favorite DTC advertisements is the new concept for the use of an anti-depressant for a social disorder. Social disorders appear to be another phrase for what are known as introverts- a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease, many believe. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators of these commercials again wish to grow the market for a particular, and possibly fictional, disease state. Then there is also baldness treatments advertised, as another example by the advertisers who attempt to create a need for treatment.
Lifestyle medications are not treatment options for illnesses, and should not be portrayed as such in certain direct to consumer advertisements. Then there are the Viagra commercials with the happy man who is fully energetic on the advertisement for this drug is not your typical man who has erectile dysfunction. So DTC advertisements are intentionally deceiving to grow the markets for the benefits of the makers of the drugs advertised.
Also, DTC ads discuss only one treatment option normally, so it seems, when likely there are several treatment options that exist for authentic medical disorders. The options for treatment should be left to the discretion of the health care provider, as they are the ones who assess your health, not your television or another media source. That’s why most of the world does not allow DTC advertising, with the exception of our country and New Zealand.
Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the creators of direct to consumer advertising. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome if not awkward for the health care provider chosen by the viewer of a DTC ad for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription. Also, in some situations, the sponsor will speak and acquire a dormant/inactive actor, perhaps, or a former athletic celebrity, to fuel their intent.
Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world utilizing media outlets such as television. Perhaps this will save some over-prescribing of expensive medications that progressively has been occurring recently, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which should be far from financial prosperity. This elimination of DTC advertising would only be a start to achieve control in the U.S. Health Care System as it exists today.
“Ignorance is not innocence but sin.” --- Robert Browning
Dan Abshear
Author’s note: What has been written was based on information and belief
Published on www.brainblogger.com
When I was a child, I heard the phrase 'war-monger', I had to find out its definition, as I had no idea what that phrase meant. I knew others could, and were, labeled with this phrase, as I had heard it in the past directed at others whoever said these two words. So I felt a need to know what these words meant, and how they affected others who heard them.
Finally, I found the answer: a warmonger is one who promotes war, which is undesirable or discreditable. In this case, one labeled this would have an affinity for what others are reasonably opposed to share the same views:
Others promote other things besides war.
Disease mongering is when a large pharmaceutical corporation implements various unethical if not illegal activities in order to sell more of their products by either creating or expanding a particular illness. They do this by creating the perception that others are likely ill in some way when, in fact, they are not.
Drug companies do this by seeking more of those who should be patients in need of treatment with the drug maker's promoted medications, regardless if they are in need of such treatment or not, clinically.
How this is done by these companies will be described soon.
The drug makers clearly place the needs for their drugs to be for medical conditions whose treatment regimens are to be viewed by others as incomplete or unmet. The companies want to let the public know of the progressive increase for the disease states and how their products treat this illness better than what is available now or has been used in the past. How ironic it seems that drug companies, who make drugs to delay the progression of, or cure diseases with these drugs, wish for others to become as sick as possible to profit from their suffering that they create with disease mongering and sell more pills.
This disease-mongering in fact does occur often to widen the diagnostic boundaries of an illness, disorder, or syndrome by creating awareness of such medical conditions to the public. The drug companies do this by utilizing in several ways the delivery of fabricated if not baseless information during this process.
Usually, the pharmaceutical either creates or expands a disease state by deception directly to consumers, often. Then the consumer, who now believes that they are ill, go see their health care provider. The health care provider, due largely to the unfamiliarity of the patient’s symptoms expressed by the patient, if not the drug the patient is requesting, usually writes a prescription for the drug requested by the patient.
First, let's take a look at this label of disease mongering. It is inappropriate in that, unlike diseases and illnesses, mongering occurs with medical disorders and syndromes as well.
It is accurate and factual, however, that disease mongering does happen with deliberate intent and reckless disregard for the well-being of others by drug companies.
There was a book written by Ray Moynihan and Allan Cassels called, "Selling Sickness" in 2005. The book thoroughly described how big pharmaceutical corporations are turning all of us into patients, and into a over-medicated society.
Disease mongering progressively continues to create patients with illnesses, disorders, or syndromes that in fact may not exist without any intervention to discontinue this behavior.
What the drug company implements to make sure this happens includes the following:
1. Paying medical journals to publish fabricated clinical trials involving their promoted medications after paying those involved with such a clinical trial to create such fabricated data. That is disease mongering to the health care provider.
2. Subjective screenings, such as those for various mood disorders. These screenings, as well as the affective disorders, which were rare until about 1995, involve leading questions often- created by the drug company. It was around this time that the United States was becoming more of a psychotropic nation.
These screenings that involve the leading questions responded by select groups of people. They are asked these questions by certain disease state support groups who have been converted into front groups after being funded by those big pharma companies who produce drugs for particular mood disorders.
3. Disease creations I: Social Anxiety Disorder, or social phobia: This condition is in the DSM IV which was published in 1994, and some were forced to delete the statement regarding this disorder that said, "Social Anxiety Disorder is not well-established, and requires further study."
Aside from what may be simply amplified introversion, social phobias are likely due to societal dysfunctions and certainly should not be labeled as a pathological condition requiring pharmacological treatment.
4. Disease creations II: Premenstrual dysphoric disorder. I call this a mid-life crisis, yet it was entered by instruction by the APA (American Psychiatric Association) into the DSM (the psychiatrist's bible) in 1993. Anxiety about the inevitable does not require pharmacological treatment.
5. Direct to Consumer Advertising:. Most memorable were those commercials for erectile dysfunction. Their absurdness in creating these commercials appears to have multiple psychotic components:
A healthy man who could probably run a marathon is having a decent time with his wife at some upper- middle class location. He is smiling all the time. Because now, his marriage is secure due to his ability to copulate- which was apparently absent before this wonder drug entered his system. Of course, it is not possible to have a happy marriage without intercourse, right?
Then there are other conditions which are entirely natural in the human lifespan, yet have been determined to be diseases by those who can profit off of these lifespan events. Examples include osteoporosis and menopause, as well as erectile dysfunction. It’s insane the FDA approves pharmaceuticals for these natural events that occur normally in a human being.
Finally, there are the required medical guidelines for various disease states, such as dyslipidemia. Drug companies that make medications to treat this disease are more than happy to support the financial needs involved in creating these guidelines. Dyslipidemia, for example:
Publications such as the Lipid Letter, and Lipid Management, both offered more aggressive management of the lipid profiles of the patients of the readers. And both publications were funded completely by those big pharma companies that promote statins. Same with cholesterol screenings that occur often that are implemented by those drug companies with drugs that treat the disorder of dyslipidemia.
A myth is something unproven. A false belief, or invented story.
Disease Mongering is not a myth. Large pharmaceutical corporations promote illness and disease- not desired by anyone and discredited by many, and these companies do this for profit and profit only.
I worked for three of the largest pharmaceutical companies in the world for over a decade, and the disease mongering protocols were similar if not identical with all of these companies consistently,
Dan Abshear
http://collections.plos.org/plosmedicine/diseasemongering-2006.php
Please review the link above, as there appears to be with some in the pharmaceutical corporate world that are offended by being labeled disease mongers. Often, others are offended by facts that exist as a reaction, it seems. Clearly, disease mongering is real, and activities illustrate this behavior.
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