In Big Pharma's grasp

Physicians first in line to be manipulated

Letter to the editor, Concord (N.H.) Monitor
March 28, 2010

While the unholy and enigmatic alliances between lobbyists, insurance companies and their friends in Congress are responsible in large part for the unsettling vicissitudes of health care reform, Big Pharma must surely share in the blame game as well.

No doubt we have all been beneficiaries of research and development, which has led to major breakthroughs in all fields of medicine. We are living longer and, some would argue, healthier lives as a result of medications that forestall the damage due to age-related illness and self-neglect, or bail us out of situations that would have knocked off our grandparents.

But these days Big Pharma is throwing billions of dollars into marketing drugs that really don't do anything new or exciting. In a disturbing trend, pharmaceutical companies are in the business of manufacturing a diagnosis to their drug, rather than working on a new drug for an existing condition. From a physician's point of view, we're seeing resources shifting from the development of important new drugs to the marketing of "me too" variants of existing drugs. In an effort to gain or expand upon patent protection, an existing drug might be tweaked or repackaged ever so slightly, at great cost but relatively little benefit to the public.

So how do drug companies manage to sell drugs we don't need for conditions we don't have? Ah, the power of multilevel marketing.

Sadly, physicians are first in line to be manipulated. Our medical journals consist almost entirely of glossy pharmaceutical ads, with an occasional scientific article thrown in to justify their publication. And there are always those cozy and questionable relationships between physician researchers in academic medical centers who run the "objective" clinical trials for the drug companies. In the marketing world, a minor improvement in outcomes for an expensive "me too" drug is tantamount to the discovery of penicillin.

How does this information of dubious value make its way to the office-based physician? At times, the message is transported on the wings of angels - willowy twentysomething supermodels turned drug reps who ordinarily wouldn't talk to a frumpy old guy like me. The trouble is, after meeting with them, I can't remember which drug they were promoting. But there's a drug for that, too.

The next level of marketing involves the lavish spending by pharmaceutical companies upon members of Congress, which amounted to approximately $275 million last year. Lots of money can coax our elected representatives to feign horror at the prospect of decreasing the duration of patents, or importing cheaper drugs from elsewhere in the

world. A lobbyist's dream come true was the provision in the Medicare drug benefit (Part D) that has prohibited the government from negotiating pricing on drugs for Medicare recipients.

Finally, and perhaps most flagrantly, drug companies are able to convey their convoluted messages to the public with direct-to-consumer advertising. The United States and New Zealand are the only countries that permit DTC advertising of prescription drugs.

At an estimated cost of $4 billion in the United States last year, DTC advertising is another colossal waste of money in our health care system.

During a recent 30-minute evening network news program, I counted 10 separate pharmaceutical commercials, all with happy people cured of their depression, high cholesterol, peripheral vascular disease and asthma. These smiling and confident folks don't even break stride as the narrator rattles off a few dozen potentially fatal side effects in the last half of the commercials.

Patients then bring their requests to the doctor's office. With little time, and less energy to object, doctors take the path of least resistance and write the costly prescription. Mission accomplished.

No wonder physicians who have been practicing for a while are suffering from therapeutic nihilism.

A more comprehensive cure for all the aforementioned conditions is to get off the couch and stop watching TV.

It's a bitter pill to swallow, but Big Pharma has us all in its grasp.

And, by the way, gentlemen, if widely advertised medications do what they are supposed to do for more than four hours, please don't call your doctor. Dust off the Rolodex or dig out the little black book and see if any of those old girlfriends want to hear about it.

(Rob Kiefner is a family physician in Concord.)