Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs

391 Pages·2009·1.53 MB·English

For Michael
Contents
Introduction
Part I RX REPUBLIC
ONE Creating Disease
TWO Midwestern Medicine Show
THREE Chemical Imbalance
Part II THE RISE OF THE MEDICINE MERCHANTS
FOUR The Early Years
FIVE An Awakening: The Age of the Blockbuster
SIX Ghostwriters and Secret Studies
SEVEN “Neurontin for Everything”
Part III A BITTER PILL
EIGHT Altered State
NINE Deadly Doses
Epilogue
Bibliography
Acknowledgments
Notes
Index
Introduction
DOCTORS CALL IT the resurrection drug. They have watched as it freed patients from
what seemed an inescapable death.
The medicine treats sleeping sickness, a disease far more lethal and
terrifying than its name implies. Opportunistic tsetse flies spread the disease
through much of Africa, devastating villages and killing tens of thousands of
people a year. The jewel-eyed yellowish brown flies thrive in thickets along
rivers where women and children go to collect water. With a bite, the
bloodsuckers inject deadly parasites into their human victims. As the parasites
multiply, their human hosts appear to go mad. The victims grow agitated and
confused, slur their speech, and stumble. Finally come coma and death.
The pharmaceutical company that manufactured the medicine, a failed
cancer drug with the tongue-twisting name eflornithine, abandoned it in 1995,
seeing no profit in selling it in poor countries.
But the resurrection drug made its own revival a few years later—not in
Africa, but in the United States, a land free of tsetse flies but with fourteen
million women worried about unwanted facial hair. Another company began
selling it in the form of a depilatory cream to minimize female mustaches. With
its lavender-colored logo resembling a graceful swan and advertisements
sporting young, beautiful models, eflornithine became another prescription drug
marketing success.
The company christened its product Vaniqa.

THIS IS A book about a great transformation in the prescription drug industry over
the last twenty-five years. Once the most successful pharmaceutical companies
were those with the brightest scientists searching for cures. Now the most
profitable and powerful drugmakers are those with the most creative and
aggressive marketers. The drug companies have become marketing machines,
selling antidepressants like Paxil, pain pills like Celebrex, and heart medications
like Lipitor with the same methods that Coca-Cola uses to sell Sprite and Procter
& Gamble uses to sell Tide.
Selling prescription drugs—rather than discovering them—has become the
pharmaceutical industry’s obsession.
Prescription drug marketing now permeates every corner of American
society—from Sesame Street to nursing homes to the nightly news. Medicine ads
sprout from billboards, scoreboards, the hoods of race cars, and the back covers
of magazines—all once venues of the similarly ubiquitous cigarette ads of the
1960s and 1970s. Imitating neighborhood grocers, the drugmakers offer
coupons, free gifts, and deals to buy six prescriptions and get one free. They
hold sweepstakes and scholarship contests. They pay to sponsor rock concerts,
movie premieres, and baseball’s major leagues.
The marketers make the use of their dangerous medicines look attractive and
easy. Fentanyl, an addictive narcotic eighty times more potent than morphine,
comes in a berry-flavored lollipop. Syringes used to inject children with growth
hormone look like kaleidoscope-colored writing pens and PlaySkool toys. In
2006 drug companies gained approval to coat their pills with “pearlescent
pigments” to enhance them with a shimmery satin luster and make them look as
precious as their price.
During New York’s 2003 Fashion Week, swimsuit models shimmied down
the catwalk, showing off Johnson & Johnson’s new contraceptive, a white-
colored patch that was glued to the skin. By wearing the drug as a fashion
accessory, one company executive explained, women “can look beautiful and
feel confident.”
Men attending professional golf tournaments in 2004 heard a different pitch.
Step right up for free tips on your golf game, offered marketers working in a tent
promoting Cialis, a drug for erectile dysfunction. Step right up for a free video
lesson from a sports psychologist, the salesmen invited. By the way, they added,
do we have the perfect drug for you!
America has become the world’s greatest medicine show.
The marketing works. Never have Americans taken so many prescription
drugs.
Americans spent $250 billion in 2005 on prescription drugs, more than the
combined gross domestic product of Argentina and Peru. Americans spent more
on prescription drugs in 2004 than they did on gasoline or fast food. They paid
twice as much for their prescription medicines that year as they spent on either
higher education or new automobiles.
The American prescription drug market is so lucrative that many foreign
drug companies have moved in and now depend on Americans for most of their
profits. For foreign executives, the math is simple. Americans spend more on
medicines than do all the people of Japan, Germany, France, Italy, Spain, the
United Kingdom, Australia, New Zealand, Canada, Mexico, Brazil, and
Argentina combined.
As the medicine merchants have poured billions of dollars into selling their
wares, they have become America’s most powerful industry. In the process, they
have transformed American life. The small white-capped whiskey-colored
bottles that once took up a corner of the bathroom cabinet now play a role in
lives that few products can match. Almost 65 percent of the nation now takes a
drug available only by prescription. Children line up in the dining hall of their
summer camps to get their daily doses. Pharmacies stay open twenty-four hours
to meet America’s demand. Even the dogs get Prozac if they howl too much at
the moon.
The pharmaceutical companies build their laboratories on the campuses of
public universities. They recruit patients for clinical trials at shopping malls and
county fairs. On network television, the plots of prime-time shows revolve
around brand name prescription drugs, at times at the suggestion of marketers at
a pharmaceutical company.
The medicine promoters have turned what were once normal life events—
menopause, despair from a divorce, anxiety caused by a workaholic boss—into
maladies that can be treated with a pill. After all, when patients are customers
and medicines are commodities, the industry thrives when people are ill—or
believe they are.
The companies have found the United States, with its consumer-driven
culture, a perfect medicine market. We expect instant gratification of our desires
and a quick fix for whatever bothers or distracts. Americans are eager to believe
in the panaceas offered in the six drug commercials that regularly accompany
each evening’s news. We are told—and want to believe—that we can swallow a
pill and soon be dancing on a dinner cruise, running on the beach, or playing
football like John Elway, the former NFL quarterback and promoter of Prevacid,
a heartburn pill. If we eat too many cheeseburgers and fries, there is comfort
knowing one pill will settle our stomachs while another brings our cholesterol
back down.
In the condos of Palm Beach, the bungalows of Los Angeles, and the
farmhouses of Iowa, people are taking more and more pills. The average
American collected more than twelve prescriptions from his pharmacy in 2006,
up from eight prescriptions in 1994. Older Americans take home even more—an
average of thirty prescriptions each year.
In 2003 Secretary of State Colin Powell explained the nation’s new
prescription habit to a journalist for the Arabic newspaper Asharq Al-Awsat.
“So do you use sleeping tablets to organize yourself?” asked the writer,
Abdul Rahman Al-Rashed.
Abdul Rahman Al-Rashed.
“Yes. Well, I wouldn’t call them that,” Powell replied. “They’re a wonderful
medication—not medication. How would you call it? They’re called Ambien,
which is very good. You don’t use Ambien? Everybody here uses Ambien.”
There is a problem, however, with the new American way, one that the drug
companies and doctors prescribing the medicines do not like to talk about.
Experts estimate that more than a hundred thousand Americans die each year not
from illness but from their prescription drugs. Those deaths, occurring quietly,
almost without notice in hospitals, emergency rooms, and homes, make
medicines one of the leading causes of death in the United States.
On a daily basis, prescription pills are estimated to kill more than 270
Americans—more than twice as many as are killed in automobile accidents.
Prescription medicines, taken according to doctors’ instructions, kill more
Americans than either diabetes or Alzheimer’s disease.
America has become “a grossly overprescribed nation,” says Dr. Arnold
Relman, professor emeritus at Harvard Medical School and the former editor of
The New England Journal of Medicine. “Again and again you see examples
where patients get far more medication than they need. The average senior in
America is probably taking twice or three times the medications they require.”
Doctors prescribe one drug only to create new problems for the patient with
the pill’s side effects. Rather than realize the medicine is making them ill,
patients believe they are just getting old and ask for even more pills. Arthritis
patients get pain relievers, which raise their blood pressure. At their next visit,
doctors prescribe medicines for hypertension, which come with a whole new set
of adverse effects.
It is estimated that the nation may now pay as much to care for patients who
were harmed by their prescriptions as it spends on those medicines in the first
place.
Despite these injuries and deaths, the medicine merchants have not stopped
with adults. They are now targeting the increasingly profitable and fast-growing
medicine market for children. The companies’ marketers have created
storybooks, video games, and soft, cuddly toys to attract children’s attention.
They have also learned to aim their appeals at parents’ desire to have the perfect
child. Parents of short children are told that daily injections of human growth
hormone can help their son grow inches and be better accepted by his peers.
They are told that Ritalin will help their daughter get higher grades. An
antidepressant, they learn, may help their shy child play with other kids. In 2002
and 2003 prescription spending rose faster for children than for seniors, baby
boomers, or any other group.
But so far scientists know little about the long-term effects of using powerful
But so far scientists know little about the long-term effects of using powerful
adult drugs in children, making the booming pediatric market a grand American
experiment. The drugs have already harmed thousands of children. Federal
regulators received more than seven thousand reports of drugs harming infants
and toddlers under age two between 1997 and 2000, according to a university
study. More than 750 of those children died.

THE VAST MAJORITY of the industry’s marketing dollars is directed not at consumers
but at physicians, the gatekeepers whom patients trust. In 2004 the industry
employed an army of 101,000 sales representatives to call on those doctors—two
and a half times the size of its sales force in 1995. There is now one drug
salesperson for every six physicians, each with an expense account that lets him
shower doctors with gifts and cash. Surveys show that virtually every American
physician now takes these handouts.
Sales representatives at a company called Tap Pharmaceutical Products gave
frequent prescribers of its medicine Lupron television sets and VCRs for their
offices and tickets to Broadway’s Phantom of the Opera. When a doctor asked
the drug company to pay to relocate his office, Tap’s executives wrote a check.
When physicians wished they could earn more money, Tap paid up to $25,000
for consultants to guide them on how to be better businessmen.
A training manual for Tap’s salespeople explained they should expect
doctors and hospitals to ask them for cash. The sales reps could deliver the
money, the manual directed, as long as they remembered that “the primary
factor” was “what will the grant do for you and your company.” The company
expected doctors receiving the gifts to return the favor by writing more
prescriptions. “If a non-user physician asks for money,” the manual instructed,
referring to doctors who did not prescribe Tap’s products, “ask for scripts.”
By the beginning of the twenty-first century, doctors had come to count on
the industry’s handouts. “It’s nice after an exhausting day at work to go to a
dinner, sporting event or spa where we can discuss with our peers and learn
more about treatments for various diseases,” wrote Dr. Nancy Sika and Dr.
Colleen Heniff in a letter to federal officials in 2002 when the government
proposed restricting some of the gifts. “Why are we singled out by the
government not to have the same perks as other businesses?
“As physicians we are a very ethical, intelligent group,” they wrote. “I have
not seen us be swayed to use a product just because we were taken out.”
But patients tell stories of how their doctors gave in to the sales pitches. Mrs.
Albert F. Rust of Kirtland Hills, Ohio, said she was horrified as she watched a
doctor switch her elderly mother to a new drug that was heavily promoted from
doctor switch her elderly mother to a new drug that was heavily promoted from
one that seemed to be helping her. “The representative of the company has been
after me to switch my patients,” the doctor had explained.
“We were helpless,” Mrs. Rust said. “I cried and so did Mom. She was 87
years old and a timid elderly person. I won’t forget her confusion and sadness.”

BECAUSE ONLY ABOUT 10 percent of the price of most brand name pills goes to cover
the cost of the raw chemicals and manufacturing, the industry has plenty left
even after paying for advertisements, research, and the high salaries and
expensive perks of its executives. While patients and taxpayers have been left
with emptied pockets, the drugmakers have been flush with cash. From 1995 to
2002 they were the nation’s most profitable industry. In 2004 the pharmaceutical
companies turned nearly sixteen cents of each dollar of revenue into profit,
according to Fortune magazine. That compares with the median profit earned by
America’s five hundred largest public companies that year of a little more than
five cents.
With their hoards of cash, the companies have readily handed money to
patient groups, hospitals, universities, medical schools, physician societies,
government agencies, and just about any organization they want on their side.
Harvard, for one, has a lecture hall named for Pfizer in a building named for
Mallinckrodt, another company.
The industry’s cash-filled coffers have given it a stranglehold on medical
science. Most of the nation’s best academic medical minds have at some time
been on the industry’s payroll as consultants. As the drug companies’ influence
has grown inside our universities, research priorities have abruptly shifted to hurt
the public’s interest. Professors see more money in working on the next
blockbuster heartburn medicine than in studying the environmental causes of
cancer. They and the companies that financially support them are more
interested in developing hair loss treatments and other lifestyle drugs for rich
Americans than in discovering cures for diseases like malaria, which is
devastating poor countries and killing a child every thirty seconds.
The drug companies’ chain of influence is so complete that there are few
people left to look objectively at the effects of their products on the nation’s
health or at the consequences of their power for society.
Washington is the axis of the industry’s power. The pharmaceutical
companies spent more on lobbying between 1998 and 2004 than any other
industry. By 2004 the companies employed a legion of lobbyists so large there
were more than two for each member of Congress. By using their wealth to buy
influence, the drug companies have repeatedly squelched attempts to regulate