The Bigger Picture:
Big Pharma, its lackeys (the FDA, the medical
Institutions, and US Congress), MONEY, MONEY,
MONEY, a pill-popping national mentality,
and, you.
I cannot do (summarize) more successfully here what others have already done so exactingly well in books and articles. So these are just some book reccs. Then a brief laundry list of key points about Big Pharma, for people who will not or cannot buy the books. However, if you care at all the state of American medicine, your health and that of the people you love, affordable medicine, or what giant businesses (Big Pharma) and the government is doing, I HIGHLY SUGGEST you read one. If you live or work in America than that is cause enough to put these on your Must-Read List, actually buy one, and actually sit down and read it.
Are these the only good books out there on the topic? Not by a long shot. There's a whole industry of 'em. Are these the "best"? Maybe, maybe not. So why did I choose them? Just cuz they're the first ones I read? Uh, kinda. And because I chose them as starters for a reason: They're of digestible length, broad in scope but coherent, easily readable, credible, cheap, and incredibly useful to get you started on the topic. So here goes.
Generation Rx by Greg Critser (on Amazon)
Learn about the rise of Big Pharma, the story of the FDA, and a lot about medicine and how pills do (or don't) prove that useful, and how they can be harmful. (I'd write more about this book but it's on the other side of the ocean right now. I assure you it is a good one.)
After that, you can move on to:
The Truth About the Drug Companies by Marcia Angell, MD (on Amazon)
I consider this a good choice for reading after Generation Rx because while she does not talk as much about the time-line of events (the back-story to the FDA and Big Pharma), she goes into great detail about many of the things Generation Rx explains in a more general sense. She explodes the myth that the drug prices are higher in order to cover high R&D (research and development) costs and that the drug companies are worth the money for the innovative new drugs they serve up (don't serve up...). She explains precisely how and to what extent they have their hands in the medical industry, ongoing medical "education" for doctors, the government, the FDA, and more. A MUST-READ.
Then, when you feel overwhelmed and terrified of all medicine, calm down with:
Over-Dose by Jay S Cohen, MD (on Amazon)
A bit old but still a good read (he has many other books too). I recommend it because, in his almost-too-repetitive, no frills, down to earth style, Dr. Cohen assures us that issues with safety and side-effects (assuming we should be on the drug in the first place...) can be lessened or even eliminated simply by LOWERING THE DOSAGE. For various reasons (read for yourself), the standard starting dose of a drug is much higher than it should be; and even if the starting dose is "acceptable," who is to say that YOUR body might not need less? (Especially if you are smaller, weaker, or more petite than a healthy 200 lb young adult male, the standard for judging "proper" doses.)
Related personal anecdote: The book has a lot to say about Lipitor. My grandfather, 80, was recently put on it. Purely precautionary (ie: no existing problem). The standard starting dose: 10mg/day -- even though amounts as small as 2.5mg might be effective for elderly people. HIS starting dose? No idea why, but, TWENTY MG a day! Luckily, my grandmother had been flipping through my copy of Over-Dose at our house the other day, and demanded a lower dosage. (They settled on 5 mg/day.)
I really suggest that you read at least one of those first two books (or any book; I hear $800 Million Dollar Pill is good, and a myriad of others; and I myself want to buy Selling Sickness next). But for those who cannot be swayed to buy and read a book based on a stranger's insistence, I will knock off a list of the types of issues and facts these books address.
BIG PHARMA IS RICH. Not just rich. Or RICH. I mean *$*RICH*$*. "In 2002 the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion)" (The Truth, p.11). NEVER FORGET HOW IMPORTANT MONEY IS TO BIG PHARMA.
Big Pharma does NOT need to charge an arm & a leg to cover R&D (research and development) costs. Nor does it improve our lives with frequent discoveries of innovative new miracle drugs. It mostly puts out Me Too drugs (slight variations on existing drugs, generally for minor chronic ailments). They barely do their own research; they buy the rights to drugs that other companies (universities or private research companies) have invented, and reap mind-boggling profits when a drug becomes a blockbuster.
The magic figure $800 million (what they say it costs to produce a new drug) is a lie. Dr. Angell estimates it at about $100 million (p. 46). To Big Pharma, that's small potatoes.
The industry admits to spending, in 2001, $19 BILLION on marketing (The Truth, p.136). You'd think that if they were really churning out such innovative, life-saving drugs that work so well, and only selling drugs to people who need to and should be on them, they'd hardly need to spend so much money spreading the news and convincing people.
Big Pharma doesn't want to make a cancer-curing pill. Where's the profit in CURING something, or in a drug for a problem few people have? They'd rather sell drugs for petty, chronic ailments. They want people buying heartburn pills and allergy meds and anxiety meds -- every month, for decades and decades on end. Much more profitable, no?
DTC (Direct-to-Consumer) advertising is banned in all "advanced" countries but New Zealand -and the good old US. They work well: "Honey bunch? Come watch this -- I think I have generalized social anxiety disorder!" Pretending to spread "awareness," they actually promote new diseases in order to sell drugs. This is a standard Big Pharma tactic: It's not indigestion; it's acid reflux! And do you know how successful Prilosec and Nexium are? "Acid reflux" does not even occur the way they say it does or for the reason they say it does, by the way, and the medicine might do more harm (to your liver) than good (Generation Rx).
The FDA is beholden to Big Pharma. In fact, it's on its payroll, due to the Prescription Drug User Fees Act (Generation Rx, & The Truth).
Furthermore, most members of FDA advisory committees have financial conflicts of interests (ie. they are financially vested in the company that produces the drug being discussed). In 2000 "at 55% of meetings, half or more of the FDA advisors had conflicts of interest" (The Truth, p.210).
FDA standards are extremely lax. Only two clinical trials are required. Worse yet, rather than needing to be proven better and/or safer than existing, cheaper drugs for the same purpose, Me Too drugs need only be proven more effective than a placebo. Wow, THAT's where all that R&D money goes, huh? To making something that works better than a sugar pill - and it's fine if it's less safe than existing meds.
The biggest lobby in Congress, by far, is that of Big Pharma. As you could guess, they have major financial ties to innumerable politicians on all levels.
Big Pharma has unbelievable control (both legal and illegal) over what gets (or does not get) published in medical journals. Generally, it is legal for them to suppress negative results. They do lots of illegal things too, like take any results that seem positive and publish them various times in slightly different forms to make it more impressive, or pay doctors thousands of dollars to fake authorship on ghost-written articles.
Big Pharma holds the medical industry in the palm of its hands. I cannot even begin to describe the exorbitant bribes, gifts, "incentives," whatever you wanna call it, given to doctors.
Big Pharma has an enormous hand in doctors' medical education. Doctors are required by law to undergo continued medical training, generally in the form of lectures or seminars. You can imagine how unbiased a seminar on treatment options for a certain disease would be when put on by a drug company that produces its own treatment option... Often, luxurious gifts are involved too, and the seminars take place in nice places like Hawaii. In 2002 alone, the industry is estimated to have hosted "over 300,000 pseudo-educational events" (The Truth, p.142).
With drug reps and drug companies doing so much "educating," many medical schools don't even bother with basic pharmacology courses anymore (The Truth).
When a doctor puts you on a new drug, beware: he or she might be getting paid several hundred or even several thousand dollars a head for enrolling you in a study.
Big Pharma thrives on monopoly tactics, abusing lawsuits and loopholes any way it can in order to gain extra years on its patents and hold back generics. Read in The Truth just how ridiculous the patent stuff can get, and how they crush (or strike deals with) the generic companies.
When Big Pharma finally loses a patent and the same drug is available in cheap generic form, it makes sure to first create a new version of the same drug (only more expensive and with a new name) and to convert all its customers to the new one just in time. Why buy cheap OTC Claritin when you can get the new-but-not-improved expensive Clarinex? When Prilosec's patent ran out, they came out with prescription Nexium (AND managed to keep profiting from Prilosec by getting 3 years exclusive OTC rights on Prilosec.) No generics here! (The Truth, p.185).
Big Pharma gets sued increasingly often, but hey, they can afford it! Example: In 1996, 47 states and the District of Columbia filed suit against Parke-Davis for its "well coordinated plan of staggering dimensions" to promote Neurontin for off-label uses (no room to get into the details of how, but all very illegal). Eight years later, Pfizer finally paid $430 million to settle these criminal and civil charges. But the profits from Neurontin sales? $2.7 billion (The Truth, p.161).
In the late 1990s South Africa threatened to produce or import generic AIDS drugs, because it could not pay American prices. In a typical American-like move, "[t]he Bush administration stood alone among 143 World Trade Organization countries in opposing the relaxation of patent protection in the Third World," though we did agree to permit them to manufacture (in certain limited situations) their own generic versions. As if the poorest countries can afford to do that... (The Truth, p.206). Anything to hold onto a patent right, right?
Very sneaky: Many patient advocacy groups are actually FRONTS for drug companies pushing a certain drug as treatment for that particular disease or condition. Most of the poor folks in the organizations are unaware. The more "grass-roots" it looks, the better.
So what should I do now? Refuse to listen to my doctor?
No, but make sure he/she isn't a Big Pharma lap-dog. Everyone, and the doctors themselves, thinks doctors are somehow above being influenced by the gifts, dinners, trips, golf outings, and marketing propaganda masquerading as research. Bullshit. So allow me to offer you this --> QUESTIONS TO ASK YOUR DOCTOR. Seriously, print it out, bring it to your appt, and DEMAND ANSWERS to these questions if he/she tries to put you on a new drug, or any drug at all. Your life and wallet are in your hands.
Is there any hope?
Honestly? I think not. And if you read one of those books, you'll feel the same. Too much money, too much corruption, too much politics involved. All we can currently do is go for damage control and self-defense (like demanding that your doctor answer the aforementioned questions). It's a shame though... Protecting ourselves from risky drugs is nice, but it would be nicer to, in addition to that, have a drug industry that creates safe and innovative drugs and sells them at affordable prices -- something Big Pharma COULD DO, if it wanted, and still turn out ENORMOUS profits. But not AS enormous, so I am sure they are not interested. I am not sure what the future holds but for now, the least we can do is keep ourselves educated. So spread the word. Oh, and, uh, write to your congressman.
contact: jori@ucla.edu
This page was created on June 12, 2008.
~*~ been over a decade now, but i'm still fighting for you ~*~