Feeling fine? The something’s wrong

Feeling fine? The something’s wrong – pharmaceutical industry marketing

Yves Engler

If it hurts we’ll find a drug to cure it. Hell, we’ll find drugs to cure ailments you never even knew you had. We’ll even invent diseases if that happens to open up a new market. Viagra for women, drugs for the “illness” of naturally decreasing bone density in aging women, a cure for hyperactivity disorder in adults, 60 new obesity pills, Prozac for seven-year-olds and a pill to curb the urge to shop are just some of what the pharmaceutical industry has to offer.

Like all capitalist industry, pharmaceutical corporations need to constantly expand. And this, they are doing. Canadian expenditures on drugs were $1.3 billion in 1980 compared to an estimated $12.3 billion last year.

The pharmaceutical industry expands through innovation in product as well as innovation in marketing. The latter is seen as more cost effective and less prone to regulatory interference. For this reason, the nine largest pharmaceutical companies in the world spent $316 billion on marketing and administration, while spending only $1 13 billion on research and development between 1991 and 2000.

The majority of drug advertising goes mostly unnoticed by the public since it’s directed at doctors. Usually it consists of drug company salespeople frequenting doctors’ offices with samples of pills, gifts and drug information. According to a Globe and Mail article in 2001, “an estimated $1 billion (or $20,000 per physician) will be spent by the pharmaceutical companies this year on marketing for hundreds of drugs.” Recently, there has been a proliferation in the number of drug representatives visiting doctors. Although no numbers are available for Canada, according to s recent article in the Economist, “the number of drug reps in America alone has almost tripled since 1995, to some 90,000 last year, even though the number of doctors has barely budged.”

The regulation of pharmaceutical drug promotion to physicians is mostly left up to the drug industry itself. This gives the industry a huge capacity to deceive doctors and even buy them off. A 1995 American study analyzed more than 100 statements made by pharmaceutical-company sales representatives in their presentations to doctors and found that 13 percent of the statements were inaccurate. Commonly, drug representatives either made their drugs sound better than they were or downplayed their side effects. So it is no surprise that drug companies’ gifts, including toys, dinners and “educational” trips to Jamaica have been shown to increase the writing of prescriptions.

The Wall Street Journal reports that in addition to wooing doctors individually, the drug industry “hires as consultants leading doctors as ‘thought leaders’ who talk up the pills or the science behind the pills at medical meetings. The big drug makers provide 60 percent of the financial support for continuing medical education classes [exact Canadian numbers are not known], often using the sessions to promote medicines as doctors keep their credentials up to date. They provide funding for patient-advocacy groups that in turn help to promote newer, more-expensive medicines.”

With billions at their disposal, the drug industry doesn’t leave a stone unturned. They throw their money everywhere, including at medical students and where diligent doctors search for impartial advice. Medical journals are full of ads directed towards doctors. Moreover, even the prestigious New England Journal of Medicine allows scientists to receive up to $10,000 from the very drug company whose product they assess. Still more perverse, is that the pharmaceutical industry funds bio-ethicists. According to the Provincial Health Ethics Network, “the pharmaceutical and biotechnological industries are funneling more and more cash into the pockets of academics who teach and study ethics. Some of it goes straight to individuals in the form of consulting fees, contracts, honoraria, and salaries. Some of it – such as gifts to bioethics centers – is less direct.”

Increasingly the pharmaceutical industry is advertising directly to consumers. Even though Direct to Consumer Advertisements (DTCAs) are supposed to be illegal in Canada, the law is poorly enforced. Plus, DTCAs are legal in the USA, so Canadians who watch American TV stations are often exposed to this insidious form of advertising. Also, the interpretation of Canadian DTCA restrictions have recently been relaxed. Now manufacturers may advertise the name of a drug, but not the approved use. Or they can advertise the disease but not the drug’s name. Drug companies constantly blur these lines. You may have seen the ad: “The acne solution for women only” (a photo of a woman whose name, Diane, just happens to be the key word in the trade name of the prescription drug being alluded to) or others similar to it.

If the pharmaceutical industry and media corporations lobbying campaign is successful, Canada will fully liberalize DTCAs. To further this aim, big pharma decided a “grassroots” campaign was needed. Thus they created Advocare an advocacy group that lobbies for the consumers’ right to be bombarded by DTCAs.

Fully liberalizing DTCAs, however, should not be a change made lightly. Evidence shows that DTCAs create pressure on doctors to prescribe and that they harm the doctor/patient relationship. Similarly, since they stimulate unnecessary drug use they would cost Medicare and other drug plans a large amount of money. In 1998, the year after the USA legalized DTCAs, an estimated $13 billion was added to the USA total drug bill. It is not just that newer and usually more expensive drugs get prescribed, but that the enormous cost of the ads themselves – about $2.5 billion in 2000 – need to be recouped through higher drug prices.

Like all advertisements, DTCAs are one-sided and reflect the opinions of the drug manufacturer. According to Women and Health Protection, “thirty-three medicines were advertised on American TV between late 1997 and the end of 1998. The ads for 17 of these 33 drugs – more than 50 percent – were found to violate Food and Drug Administration regulations, most commonly by downplaying risks.”

Drugs companies advertise because it is more profitable to push consumption than to research new drugs. As a result, too often the drugs we consume are quick fix solutions to complex health problems. For the pharmaceutical industry, however, pill popping is more profitable than preventive health promotion, which nine times out of 10 will do more to improve human well-being.

Yves Engler is studying political science at Concordia University in Montreal.

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