If you go by their portrayal in movies and TV shows, you'd think that huge pharmaceutical corporations make all their money by turning children into zombies and having them steal grandma's heart medication, or whatever the plot of Resident Evil was. But the truth is that Big Pharma (as hippies and crackpots call it) isn't a modern-day Legion of Doom. They're businesses focused on making money, just like every other company out there ... which isn't to say they aren't capable of evil. They totally are. It's just that their evil usually involves less illegal genetic experiments and more down-to-earth jerk moves like ...
The name of a drug is a crucial part of its marketing. The antidepressant Prozac, for example, is meant to sound sciency, while the drug Sarafem, which is targeted at women, sounds distinctly feminine. However, the only differences between these supposedly very different drugs are their names and colors: Sarafem is actually just Prozac, because Eli Lilly, the drug company behind both medications, wanted women to take the drug without telling them what it was.
Warner Chilcott/Eli Lilly
Sarafem was marketed as the cure for an ailment called premenstrual dysphoric disorder -- essentially, all the unpleasantness that goes along with menstruation, plus horrible panic attacks, anxiety, and souped-up mood swings. And we're not saying that Prozac doesn't treat those symptoms; it might (we're not doctors). We just think that tricking people into taking drugs they wouldn't otherwise take is a moral gray area, although it could be forgiven if it was done for noble intentions. Like, say, if women suffering from PMDD really needed to take Prozac but were avoiding it due to its negative association with depression. That, however, is not what happened here.
Prozac was a huge money maker for Eli Lilly, and Sarafem was released only a few months before their patent on Prozac was set to expire. When a drug patent expires, its price drops sharply, as competitors start releasing their own generic versions. But by releasing a new drug identical to Prozac, Eli Lilly managed to extend their patent by a few years, allowing the price of Prozac to remain nice and high.
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In 1997, GlaxoSmithKline did something similar when they released the well-known antidepressant Wellbutrin as a pill that helps you quit smoking, but only after rebranding it as Zyban. Again, the science behind the drug might have actually been sound, but it doesn't change the fact that deceiving people into taking mind-altering drugs is something you usually expect to end with James Bond blowing up a skull-shaped island fortress in the middle of the Pacific.
All right, so how exactly do doctors know what medication to give you, when new stuff is coming out all the time?
Well, they read medical journals, which are full of studies telling them what's working these days. Unfortunately, pharmaceutical companies know that, so when they roll out a new product that they know occasionally gives patients uncontrollable diarrhea, they first release an overwhelming number of falsified studies that replace the word "diarrhea" with "kittens."
OK, the actual practice is a little more subtle than the kitten thing. In one real case, drug company Medtronic paid $210 million to dozens of surgeons to sign their names to medical articles that were drafted and edited with the help of Medtronic marketers to advertise the company's bone-growth product Infuse ... the same Infuse that was later linked to cancer and infertility in men, which might have affected any of the million people who were prescribed it. The warnings were always there in the fine print, but the marketers were able to tweak the wording to play up the benefits and brush off the horrifying risks and side effects. The authors who went along with it could later be seen wearing lab coats made of solid gold.
But even when drug companies go to the effort of conducting genuine scientific studies, oftentimes they simply don't publish the unfavorable results. In one experiment, a number of studies of an antidepressant medication were submitted to a drug regulatory authority, and in the end, only the studies that yielded favorable results were released to the public. Oh, did we forget to mention that the studies were funded by huge pharmaceutical conglomerates? This is why some researchers believe that the vast majority of studies on antidepressants are unreliable at best and completely idiotic at worst.
But what about independent studies that aren't paid for by big businesses? Sure, they exist, but many of the researchers end up getting sued, and the studies are kept from publication by the drug company lawyers. Remember, the companies don't even need to win their suits -- all they need to do is keep bringing the scientists back to court until they run out of money and resort to burning their research notes for warmth.
Other than medical journals, the other way for doctors to stay informed about drugs is through sales reps, who visit medical professionals and tell them about the newest pill-magic their company has come up with. Sales representative visits are basically the medical education equivalent of a pizza delivery in a porno, by which we mean that they are quick and convenient and usually end with someone getting fucked. The bad news? That someone is usually us.
In most countries, drug sales reps are legally required to disclose all relevant information about a drug they are promoting to the doctor, not just the fun stuff. But in the U.S., Canada, and France, it's been found that they only mention serious drug risks 6 percent of the time. Because, you know, they're in sales. Their goal isn't to inform; their goal is to get the doctors to sign on the dotted line -- and your doctor is just as susceptible to slick sales techniques as anybody else.
So what's the risk here? Well, more than half of the drugs whose downsides aren't mentioned carry the most severe warning that can be issued -- we're talking "may cause death" territory here. And that's just for the risks -- things that might go horribly wrong when someone takes the drug. This is not to be confused with side effects, which are things that will almost definitely go horribly right if you take the drug. But again, sales reps won't even mention side effects in 59 percent of the cases.
Part of the problem is that some hospitals might be greeting over a dozen sales reps a day. The doctors want to listen just long enough to get the merchandise and free samples, but not a moment longer than they have to. This leads to super condensed sales pitches, and if something's going to get cut, it'll be the downsides. A far larger part of the problem, however, is that despite the law being pretty clear on these points, there's practically no oversight or enforcement of it whatsoever.
Meanwhile, the drug companies are spending billions on TV ads telling patients to demand these drugs from their physician. So, the doctors are getting pressured from all sides. But really, why should they worry about it when they just read that informative journal article talking about how safe the drug is?
And if we're making it sound like there are paid shills everywhere, well, that's because drug companies are ...
You can't read any product label nowadays without discovering that it's been endorsed by the American Society of Whatever, recommended by the National Center for Stuff, or enjoyed by the International Institute of Things.
As it turns out, most of these groups are pharmaceutical industry shills recommending medication based not on rigorous research, but rather the name that appears on their checks. Take the American Acne and Rosacea Society, for example. It's a theoretically impartial organization that's factually funded almost entirely by manufacturers of acne medication like Galderma, which has 13 of the 15 AARS experts on its payroll. So when AARS recommended a treatment for acne, it was no surprise that they went with Galderma's $2,500-a-year plan, instead of the equally effective $120-a-year generic alternative.
According to a study from the Journal Sentinel, among 20 clinical guidelines for the top-selling drugs in the U.S. (including Nexium, Lipitor, and Oxycontin), 16 were drafted by doctors with clear ties to drug companies. Case in point: GlaxoSmithKline's asthma medication Advair was America's fifth best-selling drug of 2011, thanks to a recommendation by the National Heart, Lung, and Blood Institute, which might have come about because 12 of the institute's 18 panel members were being paid by GSK.
But it's one thing when a bunch of professionals basically recommend brushing your teeth with dog food just because they're sponsored by Purina. It's a whole other thing when their shilling can kill you.
Let's take what drug giant Wyeth did in 2002, after discovering that their hormone therapy drugs for menopause increased risk of breast cancer, heart disease, stroke, and blood clots. The problem was that the drugs Prempro and Premarin were already on the market, so instead of recalling them, the company spent $12 million forming the Council on Hormone Education, 85 percent of whose members were working for Wyeth. They then spent the next six years conducting an online course "educating" thousands of doctors about how totally awesome hormone therapy is, and how all that cancer/stroke business was probably due to something the patients did in their free time.
And in some cases they can take a, well, more direct approach ...
It turns out that big drug companies hand out bribes -- extensively, frequently, and usually in foreign countries. For instance, GlaxoSmithKline is currently under investigation for dishing out about $500 million in bribes to Chinese doctors, government officials, hospital administrators, and anyone else who happened to be standing around at bribe o'clock. The payouts were meant to secure the company a bigger market share in the country by, assumingly, getting the government to crack down on the GalaxySwitchPine knockoffs that have been flooding China.
Since then, the company made the heroic decision to investigate themselves and found that the entire bribe thing was orchestrated by four senior executives who acted alone, against company guidelines.
But in light of GSK's vehement "It was all a few loose cannons" defense, you have to wonder what kind of illicit stuff Pfizer was really into. Because when Pfizer was caught bribing medical professionals in Bulgaria, Croatia, the Czech Republic, Italy, Kazakhstan, Russia, China, and Serbia to get them to prescribe more of the company's drugs, they quickly admitted their guilt and agreed to pay $60 million in fines.
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But really, we're surprised they didn't go with "Literally everyone does this" as their defense. When the drug giant Eli Lilly bribed Chinese officials and doctors, they had to throw in some expensive jewelry and spa treatments to secure their business interests abroad.
So what did they get for their bribes? Well, it involves straight up paying doctors and hospitals to prescribe their drugs instead of their competitors'. As in, your doctor prescribes you a pill not because it's the best one for your condition, but because the drug company bought him a new motorcycle. Wait -- it's actually sadder than that. Pfizer China allegedly "created 'point programs' that could be redeemed for gifts like cellphones and tea sets based on how many prescriptions the physicians wrote."
And ... that will hopefully be the most depressing thing you read today.
Here's a non-diarrhea kitten video. You've earned it.