Blaming the Big Drug Makers

A couple of years ago an ad appeared on U.S. television during the Academy Awards, urging viewers to have their cholesterol levels tested regularly in the fight against heart disease. It seemed like a praiseworthy public health campaign.

A group called the Boomer Coalition, fronted by Henry “the Fonz” Winkler, urged his fellow baby boomers to take action against “the most talked-about disease.” The group’s website, adorned with 1960s images of civil rights marches and peace protests, urged people to “know your numbers.”

What the ad failed to mention was that Boomer was dreamed up by a public relations agency and partly funded by pharmaceutical company Pfizer, the manufacturer of Lipitor, a cholesterol-lowering medicine that is the world’s top-selling drug.

It was one example of what health writers Ray Moynihan and Alan Cassels dub AstroTurfing, or “the creation of fake grass-roots campaigns by public relations professionals and in the pay of large corporations.”

In their forceful and well-written book “Selling Sickness,” the two authors highlight the influence of the pharmaceutical companies in “disease-mongering.”

These companies use powerful images to provoke fear in healthy people or offer a narrow medical response that downplays diet, exercise and other approaches for those who may be at risk.

The authors study diseases whose medical component and extent they say are exaggerated, including irritable bowel syndrome, female sexual dysfunction and attention deficit disorder. With regard to the last, in some U.S. states as many as 10% of white boys are given prescription drugs that are essentially legalized amphetamines.

“Having bones with a particularly low mineral density does increase a person’s chance of a future fracture,” Moynihan and Cassels write in a chapter about osteoporosis, “[but so does] whether there are loose mats in your house and whether you might need better glasses.”

The critique is nothing new. Jules Romain’s play “Dr. Knock,” about a doctor who practically turns his village into a hospital, premiered in Paris in 1923. More recently, German journalist Jorg Blech charted the trend in his book “The Disease Makers” in 2003. Since then, half a dozen anti-pharma tomes have been published in the U.S.

That is not surprising. Nowhere are the tools of influence more honed or the money greater than in the U.S. Moynihan and Cassels have done a good job in highlighting cases in the U.S., while sometimes artificially tacking on a few Australian and Canadian examples as a concession to their respective nationalities.

Big Pharma, they argue, is implicated at every level, for deeds that include giving out free pizzas and doughnuts to junior doctors, and sponsored research and funding for “key opinion leaders” who write influential articles and draft professional treatment guidelines.

The pinnacle of the industry’s influence is the $3 billion spent annually on direct-to-consumer advertising of medicines, which is defended by pharmaceutical companies as a way of keeping patients informed, and which encourages patients to press doctors to prescribe new drugs with often questionable benefit. The process is helped along by marketing advisors such as Vince Perry, who boasts of “the art of branding a [medical] condition.”

The authors do not find any explicit cases of pharmaceutical money exchanged for influence in support of patient groups, often vocal defenders of new drugs. Instead, they describe a process that is subtle, involving a “confluence of interests” between pharmaceutical groups and under-funded and generally well-meaning charities.

However, while quoting experts for and against each of the fast-growing disease areas that they discuss, the authors fail to explore the underlying science in a way that would allow the reader to better judge where the balance lies. They also underplay the positive contribution of modern pharmaceuticals, which in recent years have offered extraordinary progress in areas such as cancer treatment and the transformation of AIDS from a death sentence into a chronic disease.

Jacky Law’s “Big Pharma” launches a broader attack on the industry in a less convincing and less digestible form than that of “Selling Sickness.” Law’s basic thesis is the need for greater patient power. In recent years some people taking the anti-depressant drug Paxil have reported suicidal tendencies, and Law applauds the fact that safety warnings are now being heeded. But she ignores the silent majority who have benefited from the treatment.

Was the drop-off in mumps, measles and rubella childhood vaccinations really the result of growing public disillusion with regulators, as Law suggests? The media, including the Lancet, a respected medical journal, also gave credibility to supposed reports of side effects -- now widely discredited.

Law rightly touches on the crisis in research and development by the big companies, the risks of unknown side effects of drugs and the importance of the placebo effect. But it is difficult to draw out a coherent message from her writing.

Both books skirt recent attempts at reform, including a shift toward more nuanced consumer advertising of medicines and greater use of head-to-head trials designed to test how far new drugs really do outperform existing ones.

The authors criticize the status quo strongly, without proposing realistic alternatives. What emerges -- as a minimum necessity -- is that clinical trials should be more objective, more widely available and more understandable. They should also be framed in the context of the relative risks and benefits of medicines and disease.

Andrew Jack reports on the pharmaceutical industry for the Financial Times. This article appears by special arrangement with that newspaper.

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An industry indicted

Big Pharma: How Modern Medicine Is Damaging Your Health and What You Can Do About It

* By Jacky Law

* Carroll & Graf, $15.95, 256 pages

* Selling Sickness: How Drug Companies are Turning Us All Into Patients

* By Ray Moynihan and Alan Cassels

* Allen & Unwin/Nation Books, $25, 272 pages

Source: Publishers’ reports

Los Angeles Times