In order to understand the full impact the pharmaceutical industry has over our health care system, it is critical to know the multiple layers of influence:
1. Direct to Physician Promotion: There are 90-100,000 pharmaceutical sales reps pounding the pavement (having almost 1 million conversations per day) trying to coerce physicians to write more prescriptions of their drugs. Are these reps nurses or pharmacists? Do they possess any kind of science background? Typical reps are hired for their Ken and Barbie appearances and have more experience wining and dining and leading cheerleading squads than any form of medical experience. These reps are compensated and evaluated solely on their ability to sell more pills. Providing physicians with "free samples" of the newest drugs on the market is another effective marketing tool. Additionally over 70 percent of physician CME credits (continuing medical education) are funded by the pharmaceutical industry. Doctors are also employed by the industry as speakers, ghost writers of landmark studies, and consultants. All of this leads to an incredible conflict of interest with the medical community. (See "Side Effects" starring Katherine Heigl. Based on my decade selling pills.)2. Direct to Consumer Advertising: Our television sets, magazines, radio stations, and increasingly the internet are bombarded with beautiful and effective drug ads. "Effective" meaning they drive sales of the newest, most expensive, and often least proven drugs on the market. We as consumers are marching into our doctors’ offices in record numbers and demanding the latest and greatest pills on the market. These ads paint a beautiful Norman Rockwell life on the screen. They do a wonderful job of convincing us that we too can be this happy, this sexy, this beautiful if only we would take this pill. Overall, it is estimated that $30 billion dollars per year is spent on the marketing and advertising of prescription drugs (which is twice as much as what is spent on research and development). Who pays for this? We do in the form of exorbitant drug pricing.
3. Pharma Funding of the FDA: Due to PDUFA (Prescription Drug User Fee Act), the FDA is currently on the payroll of the drug industry. This act allows companies to pay fees to the FDA for speedy approval of their drugs, thus a large amount of the FDA funding comes directly from Big Pharma. This creates a significant conflict of interest as was bore out in the Vioxx debacle and puts into question whether the FDA can adequately be a watchdog of pharma and protect the American public. Following is a quote from Jerome Hoffman MD of UCLA from my documentary "Money Talks: Profits Before Patient Safety": "We have to have the clout and the influence and the organization to make it so that they can’t blithely go along making the FDA be something that has been widely and famously called a servant of the drug industry. We have to make it so the FDA is a servant to us."
4. Pharma Funding of the Research: Right now, 70 percent of all new drug research is funded by the pharmaceutical industry and 30 percent is government funded. With industry funding comes great control over the outcome of the data. Furthermore, study conclusions are often written by physicians hired by the drug company and published in major medical journals that take millions in drug advertising funds. These journals also receive funds for providing hundreds of thousands of "reprints" of favorable studies for the industry to distribute to physicians. But the reality is that the researchers themselves become financially beholden to the pharma company in question...their livelihoods depend on their ability to land the next big contract. This clouds their ability to deliver anything other than the results the company is seeking. Following is another great quote from Jerome Hoffman MD of UCLA: "Suffice it to say that when drug companies set the research agenda, do the research, design the research, have tremendous influence over the people who get to write it up, and in fact, have tremendous influence over the journals that publish it, then it’s not surprising that so much of what we think we know is tremendously distorted."
5. Largest Lobbying Group on Capitol Hill: Pharma has shown that another cost effective use of their money is to dominate Capitol Hill in order to get their way regarding key legislation. They are a large and powerful lobbying group who "reward" lawmakers if they vote in their favor. These rewards include, you guessed it, high paying jobs as lobbyists and consultants. A recent example of this is in regard to the Medicare’s prescription drug bill. See the excellent feature by 60 Minutes on this issue (link below).
Given the above, where can doctors and patients go to get unbiased information regarding prescription medication? Good question. One interim option is a division of Consumer Reports that shares 'best in class' as reviewed by an independent (from pharma money) body. In the meantime, we have dangerous drugs making their way to the market and a growing crisis in the attainability of affordable health care. All the while the pharma industry is pocketing enormous profits often at the expense of public health.
The information in this entry has been pared down in an effort to provide a concise summary. Following are additional resources:
"Money Talks: Profits Before Patient Safety" (you can now watch the entire film free online.)
"Side Effects" (Based on my decade selling pills. Starring Katherine Heigl and now available on DVD from Warner Bros.)
"peRx: Prescribing Evidence-based Therapies"
The Truth About the Drug Companies by Marcia Angell MD
Overdosed America by John Abramson MD
Powerful Medicines by Jerry Avorn MD
60 Minutes (great piece on lobbying influence)
