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Interesting article on prescription drug companies...

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Interesting article on prescription drug companies...

Postby Michael Jen on Mon Aug 13, 2007 9:01 pm

Risky Rx: Drug maker's secret strategies
'Disturbing' glimpse into how marketing dupes doctors - and patients

By Robert Bazell
Chief science and health correspondent
NBC News
Updated: 7:27 a.m. PT Aug 15, 2006

Robert Bazell
Chief science and health correspondent
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We know that physicians meet a parade of drug company sales representatives from their first days of medical school to retirement and that they see drug ads every time they pick up a medical journal.

At least that is represented as the advertising it is.

But a study in this week's issue of the Annals of Internal Medicine provides extensive detail about how drug companies push their products in far more subtle ways.
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Some drug makers pay key leaders in a field of medicine, such as chairs of departments in medical schools, tens of thousands of dollars if they are saying the right things about their product. They manipulate medical education sessions, lectures, articles in medical journals, research studies, even personal conversations between physicians to get their product message across.

"It is very disturbing," says lead author Dr. Michael Steinman of the University of California, San Francisco and the San Francisco VA Hospital. "It really does a disservice to patient care."

Reliable estimates put the drug industry's expenditure on promotion to doctors at $18.5 billion - that's about $30,000 a year for every physician in the U.S. Companies conceal the specifics of those efforts with a jealousy worthy of a state secret.

Now a huge collection of drug company internal documents - revealed as part of a lawsuit -offers a wealth of detail.

In 1996, Dr. David Franklin, an employee of the drug company Parke-Davis, filed the lawsuit under federal whistleblower statutes alleging that the company was illegally promoting an epilepsy drug called Neurontin for so called "off-label" uses. Under federal law, once the FDA approves a drug, a doctor can prescribe it for anything. But the law specifically prohibits the drug company from promoting the drug for any unapproved uses.

In 2004, the company, by then a division of Pfizer admitted guilt and agreed to pay $430 million in criminal and civil liability related to promoting the drug for off-label use.

Spokespeople for Pfizer say that any wrong doing occurred before Pfizer acquired the company. But Pfizer fought hard to keep all the papers related to the suit under seal. A judge denied the request and they are now part of the Drug Industry Document Archive at the University of California, San Francisco.

Steinman and his team summarized some of the key findings from the extensive collection in their paper. It is obvious why the company wanted to keep the documents from public view.

'Thought leaders'
What is most interesting is not the illegal actions they reveal, but the details of activities that are perfectly legal. And according to people familiar with the industry, the methods detailed in these company memos are routine.

One tactic identifies certain doctors as "thought leaders," "key influencers" and "movers and shakers" - those whose opinions influence the prescribing pattern of other doctors. Those whose views converge with the company goals are then showered with honoraria, research and educational grants. In the Parke-Davis case 14 such big shots got between $10,250 and $158,250 between 1993 and 1997.

"Medical education drives this market," wrote the author of one Parke-Davis business plan in the files. Many state licensing boards require physicians to attend sessions in what is called continuing medical education (CME) to keep current in their field.

At one time, medical schools ran most CME courses. Now, an industry of medical education and communications committees (MECCs) run most of the courses. These companies with innocuous sounding names like Medical Education Systems set up courses, sometimes in conjunction with medical meetings, at other times often in fancy restaurants and resorts. The drug companies foot the bill, with the program usually noting it was financed by an "unrestricted educational grant" from the company.

CONTINUED: Not innocent bystanders1 | 2 | Next >

Not innocent bystanders
The records in this case reveal in precise detail how the company attended planning sessions for the meeting and were allowed to tailor the content to meet their commercial goals.

Using MECCs, Parke-Davis set up conference calls so that doctors could talk to one another about the drugs. The moderators of the calls, often thought leaders or their younger assistants, received $250 to $500 a call. Drug company reps were on the line, instructed to stay in a "listen only" mode, but monitoring to be sure the pitch met their expectations.

The papers also reveal a "publication strategy" where the drug company would sponsor small trials of the drug and get the results published only if they met the company's expectations. If the "core marketing team" found that results did not conform to the company's goals, "the results will not be published," the documents reveal.
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Besides arranging for its own favorable studies, Parke-Davis also contracted with MECCS to develop articles, review papers and letters to the editors of medical journals putting its product in a favorable light.

The company paid the MECC $13,375 to $18,000 for each article, but the reader would not know the drug company or the MECC authored the article. The MECC paid $1,000 each to friendly doctors and pharmacists to sign their names to the articles - creating ghostwriters to make the material appear independent.

Clearly, many of the physicians in these schemes are not innocent bystanders.

Whether it is ghost writing, making telephone calls to colleagues or leading a CME session, many of the doctors got paid well. Others received a free meal or transportation to a resort to listen to an "educational session."

Physicians often claim they are not influenced by payments and perks from the pharmaceutical industry. But with the methods so thoroughly detailed in these papers, drug companies clearly believe they are getting their money's worth.
Michael Jen

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Postby Michael Jen on Tue Aug 28, 2007 10:38 pm

Pharmaceutical fraud: How Big Pharma's marketing and profits come before consumer safety and wellness

Thursday, September 07, 2006 by: Dani Veracity

If you have a long, drawn-out, incurable but treatable disease, it's unfortunate for you but great for pharmaceutical companies. While you're suffering indefinitely, you're also buying expensive pharmaceutical drugs to make the disease "manageable."

"Managing" diseases is the trend in mainstream medicine, and it's the main message that pharmaceutical companies and the media market to consumers. "You have a mental disorder? That's okay. You can live a normal life, if you take these pills every day."

According to "AIDS: A Second Opinion" authors Gary Null and James Feast, the profits "stack up better" for pharmaceutical companies when people have to take treatments indefinitely for an incurable disease. HIV, for example, is a relative goldmine, since HIV-positive people have to take drug "cocktails" each day even before they develop symptomatic AIDS. Then, the profits add up even more after these people develop full-blown AIDS because they have to take drugs to treat opportunistic infections in addition to their regular drug cocktail.

Many people believe that pharmaceutical companies' hunger for profits triumphs over their desire to genuinely help the public, and that this blinded concern for profit above all has shaped -- and continues to shape -- mainstream medicine as we know it. The bottom line is simple: As Life Extension Magazine puts it, "Marketing issues frequently outweigh medical science in drug company decisions."

Modern medicine is a platform for profit, not health
This has implications that are more serious than one might initially think, especially considering the heavy role that pharmaceutical companies play in mainstream medicine. "Deep Healing" author Dr. Emmette Miller writes, "We have to remember that most medical research in this country is financed by pharmaceutical companies who are looking for new drugs they can produce and sell."

Now, things were not always this way. In his book, "Overdosed America," Dr. John Abramson describes the shift of medical research from the academic to the commercial sphere: "As the function of medical research in our society has been transformed from a fundamentally academic and scientific activity to a fundamentally commercial activity, the context in which the research is done has similarly changed: First in universities funded primarily by public sources, then in universities funded primarily by commercial sources, then by independent for-profit research organizations contracting directly with drug companies. And most recently, the three largest advertising agencies, Omnicom, Interpublic and WPP, have bought or invested in the for-profit companies that perform clinical trials." In my view, advertising agencies having financial ties to the companies that perform clinical trials – companies that are supposed to conduct objective research – is blatant conflict of interest; yet it's the basis of most mainstream medical research in the United States. In fact, according to Dr. Abramson, in the year 2000, only one-third of all medical research was performed in universities and academic medical centers.

Since, according to these and other sources, drug companies predominantly fund medical research, scientists have almost no choice but to mainly focus their time and effort on the most profitable, but not necessarily the most effective, treatments. Though an herb, which by its very nature cannot be patented, may treat and possibly even cure a disease, drug companies may nevertheless not fund research or marketing for it, leaving the general public largely ignorant of the herb's benefits. Mainstream medicine largely dismisses vitamins and minerals in the same manner as herbs.

Furthermore, research bias often continues into the doctor's office. As Gary Null writes in his Complete Guide to Health and Nutrition, "One report published in Fact magazine speculates that the principle reason vitamin C is not commonly prescribed is that it is not as profitable as those syrups and pills your doctor dispenses."

Stealing medicine from nature
However, this doesn't mean that pharmaceutical companies ignore plants and other natural medicines altogether; it's actually quite the opposite. According to Asian Health Secrets by Letha Hadady, approximately one-third of all pharmaceuticals are derived from plants' active ingredients. Though companies cannot patent natural plants in their whole form, they can patent plants' individual ingredients after a long, painstaking process of breaking down the plant into its components, isolating active ingredients and then claiming to have "discovered" these natural ingredients. However, this system, though profitable for drug companies, has a downside that Hadady reveals: "Many times the active ingredient does not work as well as the entire plant. According to tests done in Germany, Saint John's Wort, the entire herb, kills the AIDS virus in the test tube, while hypericum, the isolated active ingredient, does not." In other words, though the bottom line is simple, it means that this society is in a very dangerous predicament indeed.

This horrific state of modern medicine is a uniquely American phenomenon, according to "Innocent Casualties" author Elaine Feuer. She writes, "Because the U.S. is the only major industrialized nation that does not regulate the prices or profits of drug companies, prescription drugs generally cost 25 to 40 percent more than in other countries." In fact, drug companies rely on American sales for the bulk of their profits, even though many of their products are marketed worldwide, says "Natural Alternatives to Drugs" author Dr. Michael T. Murray.

Though this is bad for the average American consumer, it's great for pharmaceutical companies. According to Mike Fillon's book, "Ephedra Fact and Fiction," the global pharmaceutical market earned $364 billion in 2001, making it the world's most profitable stock market sector. Fillon writes that more than half of this revenue is from the United States alone, so although pharmaceuticals are more expensive for the American consumer, Americans still buy more prescription drugs than any other nation.

Hawking for Big Pharma
Now, at this point, you're probably wondering about the role the U.S. government plays in all this. In "Death by Prescription," Ray D. Strand writes, "The FDA is actually listening and catering to the industry's desires." According to Strand, the FDA facilitates the drug-approval process. Many people attribute the FDA's bias against herbs and other natural medicine to the agency's close "friendship" with the pharmaceutical industry, but it seems that they can't agree about the level of corruption. According to American Medical Publishing's book, "Prescription Medicines, Side Effects and Natural Alternatives," "The government is also part of the problem because it does not have the resources or the political will to do more about the dangers of prescription drugs. Also, powerful members of the American government, from the President on down, are all lobbied heavily by the cash rich drug companies."

In order for mainstream medicine to reach the level of effectiveness that it can and should attain, the inner workings of the medical community must change, starting with the pharmaceutical companies' hold on the government agencies that are supposed to protect American consumers. As Burton Goldberg writes in "Alternative Medicine," "To realize effective health care with cost reduction requires unlocking the strangulation hold of the pharmaceutical companies, the American Medical Association (AMA) and ... the FDA on all forms of fully effective, low-cost alternative, complementary, integrative, holistic medicine." Until then, mainstream medicine will remain the same, and that's the last thing American consumers need. It's time to put concern for public health, medicine and genuine science over corporate profits.

The experts speak on pharmaceutical companies and profits:

There is probably nothing more profitable to the drug companies than interminable treatment of patients with drugs that do not work. Yet countless patients, at great cost to our nation, are kept on these treatments because they have been proven to help two-thirds of people and health-care providers have no policies or procedures to do otherwise. When those who pay the bills realize how much of their money is being wasted, and how much can be saved by requiring policies and procedures to identify patients not helped by standard treatment and select alternatives for them, it may happen.
Alternative Medicine by Burton Goldberg, page 458

Diabetes is such a profitable business that physicians will put pre-diabetic patients, with only marginally high blood sugar, onto diabetes drugs before even trying weight loss and exercise.
Prescription Alternatives by Earl Mindell RPh PhD and Virginia Hopkins MA, page 403

With the growing epidemic of obesity, the drug companies can look forward to a financial windfall. Many millions of Americans will be taking their statin drugs to lower their cholesterol levels. And they could each be spending $3 a day, or $1100 a year, for the rest of their lives.
Health Care Meltdown by Robert H Lebow MD, page 229

Drug companies are profit-driven entities, so marketing issues weigh very heavily. Manufacturers feel great pressure to keep costs down while hastening new drugs to market. And drug companies aren't held responsible for the huge costs of dose-related side effects to the healthcare system. The result is that marketing issues frequently outweigh medical science in drug company decisions.
Disease Prevention And Treatment by Life Extension Foundation, page 723

We have to remember that most medical research in this country is financed by pharmaceutical companies who are looking for new drugs they can produce and sell. Psychoneuroimmunology research is aimed at showing that the body is capable of producing its own healing substances. The bottom line is that stockholders of the companies that invest in medical research can't see how they can profit from such research and so will naturally put their developmental money into the money-making ventures instead.
Deep Healing by Emmette Miller MD, page 138

As the function of medical research in our society has been transformed from a fundamentally academic and scientific activity to a fundamentally commercial activity, the context in which the research is done has similarly changed: first in universities funded primarily by public sources, then in universities funded primarily by commercial sources, then by independent for-profit research organizations contracting directly with drug companies. And most recently, the three largest advertising agencies, Omnicom, Interpublic, and WPP, have bought or invested in the for-profit companies that perform clinical trials.
Overdosed America by John Abramson MD, page 110

Moreover, if a drug company's profits increase because of slanted research, hasty marketing, and misleading advertising, other companies must adopt these same methods in order to remain competitive--and the race to the bottom accelerates. This is why in any area of endeavor, codes of behavior must be periodically reexamined. Doing so is a common occurrence in politics and sports, and it is what the drug companies must now undertake.
Overdose by Jay S Cohen, page 168

An independent research center could study other uses of new medications that were not studied by their manufacturers. It could research new uses or problems with generic drugs, which drug companies do not study because the patents of generic drugs have lapsed and there is little likelihood of profit.
Overdose by Jay S Cohen, page 175

In the United Sates, pharmaceutical companies support most medication research and development. Because they really can't earn a profit from natural substances, which they can't patent, they're reluctant to fund studies on plant estrogens. Fortunately, many medical centers are helping to bridge this research gap by establishing departments of complementary and alternative medicine. At the Rosenthal Center of Columbia University, for example, scientists are conducting studies of black cohosh and other phytoestrogens.
The Rhodiola Revolution by Richard P Brown MD and Patricia L Gerbarg MD, page 179

One of the reasons for this is economic. Herbs, by their very nature, cannot be patented. Because of this, drug companies cannot hold the exclusive right to sell a particular herb and they are not motivated to invest in testing or promoting herbs. The collection and preparation of herbal medicines cannot be as easily controlled as the manufacture of synthetic drugs, making profits less dependable.
Alternative Medicine by Burton Goldberg, page 252

The FDA estimates it costs over 7 million dollars to bring a new drug to market pharmaceutical companies put that figure closer to 70 million dollars. They say they need two million users of a substance just to break even. Since natural substances cannot be patented, there is even less room for profit in them.
Scientific Validation of Herbal Medicine by Daniel B Mowrey PhD, page 291

The pharmaceutical industry is, obviously, a very powerful force in American science, medicine, business, and politics. The industry must make large profits to realize a return on investment, particularly in a regulatory system where it costs $100 to $200 million dollars to bring a new drug to market.
Choices In Healing by Michael Lerner, page 613

While it is in the interest of such companies to find patentable cancer treatments, there is no corresponding incentive to develop non-patentable natural methods. Since it currently costs around $200 million to develop a new drug in the US, mainly to comply with Byzantine FDA regulations, the drug companies claim they must seek enormous profits from each and every drug.
Cancer Therapy by Ralph W Moss PhD, page 14

In order for pharmaceutical companies to earn a profit, they must develop drugs that are potent enough to patent and can be approved by the FDA. To gain FDA approval, these drugs must demonstrate an acceptable safety profile. However, the safe dose of potent drugs can vary considerably among individuals. What is safe for some people can be a lethal overdose for others. Yet doctors and drug companies usually recommend the same dose for everyone, even though lower doses of many prescription drugs can achieve the same beneficial effects, while dramatically reducing side effect risk and the cost of the medications.
Disease Prevention And Treatment by Life Extension Foundation, page 708

In addition, since niacin is a widely available generic agent, no pharmaceutical company stands to generate the huge profits that the other cholesterol-lowering drugs have enjoyed. As a result, niacin is not intensively advertised like the other drugs. Despite the advantages of niacin over the cholesterol-lowering drugs, niacin accounts for only 7.9 percent of all lipid-lowering prescriptions.
Encyclopedia Of Natural Medicine by Michael T Murray MD Joseph L Pizzorno ND, page 352

Unlike the standard treatments for heart disease, coconut oil is cheap, has no adverse side effects, and is readily available to everyone. Because it is a natural product that is already widely available, pharmaceutical and medical industries have no desire to fund studies or promote interest in this area. There is no profit for them. Since most of the information on MCFA and coconut oil are buried in scientific literature, few people are aware of the benefits. Knowledge about the true health aspects of coconut oil has to come from experienced clinicians, authors, and researchers who are familiar with the true facts about coconut oil. Yet they face an up-hill battle because they must fight prejudice and misguided popular opinion that is fueled by powerful profit-seeking enterprises.
Healing Miracles of Coconut Oil by Bruce Fife ND, page 85

By their very nature, prescription drugs are the perfect product for a monopoly. Drugs are patented and available from only one manufacturer, and prices can be increased at the discretion of the company with few consumer complaints. How many people who are ill question the cost of drugs prescribed by their doctor? During the 1980s, inflation rose 58 percent and pharmaceutical companies managed to triple their prices. In 1990 the drug industry was the most profitable industry in America, with 13.6 percent annual profits, more than triple the average Fortune 500 company. The 1991 median profit of a Fortune pharmaceutical company was $592 million. Because the U.S. is the only major industrialized nation that does not regulate the prices or profits of drug companies, prescription drugs generally cost 25 to 40 percent more than in other countries. For three out of four elderly Americans, prescription drugs are their biggest expense.
Innocent Casualties by Elaine Feuer, page 73

Drug costs are higher in the United States than anywhere else in the world. Most major industrial nations employ profit-control measures that limit how much a drug company can charge for a drug. Because most drug companies market the same drug throughout the world, they rely on American sales for the bulk of their profits.
Natural Alternatives To Drugs by Michael T Murray ND, page 23

The global pharmaceutical industry--which generated revenues of more than $364 billion in 2001--is the world's most profitable stock market sector. According to IMS Health, the leading drug industry market analyst, half the global drug sales are in the U.S. alone, with Europe and Japan accounting for another 37 percent.
Ephedra Fact And Fiction by Mike Fillon, page 144
Michael Jen

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Michael Jen
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Re: Interesting article on prescription drug companies...

Postby Migo on Tue Apr 08, 2008 5:29 pm

Really interesting. I've read Kevin Trudeau making allegations to that effect, but while he had sound reasoning he didn't have much in the way of facts. I'd be interested to see some more detailed info on the Parke-Davis lawsuit.
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