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RESEARCHER: DRUG COMPANIES CO-OPT
DOCTORS AS PART OF MARKETING BLITZ
By Mark Gruenberg
PAI Staff Writer 

WASHINGTON (PAI)--The world’s big drug companies, unfettered by any type of price restraints in their biggest market--the U.S.--add to their huge profits by spending approximately one-third of their revenues on marketing, including marketing that co-opts doctors, a researcher on the issue says. 

And consumers pay the costs of this heavy advertising and marketing blitz, adds Marcia Angell.  The marketing includes everything from company-paid studies of drugs to underwriting medical conferences to “free samples” which get doctors and patients to use new and more-expensive, but not necessarily more-effective, medications. 

Angell, former editor of the prestigious New England Journal of Medicine, detailed the drug firm tactics in a Sept. 15 talk sponsored by the AFL-CIO Department for Professional Employees.  Angell, an M.D., recently published her results in The Truth About The Drug Companies: How They Deceive Us And What To Do About It. 

Angell pointed out the nine big drug companies are the most profitable group of firms in the Fortune 500.  Their median profit margin is 16 percent-17 percent of sales.  That’s triple the median profit margin for all firms in the list of  the world’s largest corporations.  Most drug company profits come from the U.S., which has the largest--and uncontrolled--market, she added.  Canada and Europe control drug prices.  

The firms also spend twice as much money on marketing and advertising as they do on research and development, counteracting their own claims they need high U.S. drug prices to justify expensive costs for R&D of new medications. 

Further, she noted, many of those “new” medications are so-called “me-too” drugs.  Those are slight variations on existing drugs, changed just enough to grab new patents and exclusive rights just as old patents on predecessor medications are about to expire, putting those older drugs on the market at much lower costs to consumers. 

Other “new” medications, she noted, are really developed by the government or by universities, which then sell licensing rights to the big pharmaceutical companies.  And the companies also co-opt doctors, while their record spending on lobbying buys Congress, she added. 

Doctors--sometimes unintentionally--have become captives of the companies, Angell said.  The firms influence M.D.s in several ways: 

* Sponsoring doctors’ research and clinical trials of drugs. Negative findings, or findings that the new drugs are no better than the old, are deep-sixed.  The federal Food and Drug Administration, which licenses drugs, does not require reports from failed clinical trials.  The drug companies also pay FDA fees for agency evaluations. 

* Companies give doctors “free samples” and the doctors then give them to patients.  Since the samples are of newer, more expensive drugs, “both the patient and the doctor are hooked” by the patient’s reaction to the medication, she points out. 

* Drug companies also launch millions of dollars in direct-to-consumer advertising to convince the public it needs drugs even for “illnesses they don’t know they have.”  Such campaigns increase money in company coffers as consumers ask doctors for unneeded prescriptions for such ills as excess stomach acid, she notes. 

“Their PR is extremely slick, so education is the first thing” consumers can do to protect themselves, Angell says.   

* The companies set a record in 2004 for the amount of money spent by one industry lobbying Congress and hired more lobbyists in Washington than there are senators and representatives combined.   As a result of that--and loads of campaign contributions and the industry’s own spending on advertising--Congress “is in the back pocket” of the industry, Angell said. 

That was most obvious in passage of GOP President George W. Bush’s “Medicare Rx” law in 2004.  The law bans Medicare--the largest single buyer of medicines, with more than 40 percent of all purchases--from negotiating with the companies for the lowest prices and best available drugs.   That gave companies a license to charge Medicare--and taxpayers--whatever they please.  

To combat the companies, Angell said consumers should educate themselves and refuse to accept doctors’ words, or free samples.  “Ask ‘Is there a generic drug?’  That’s because generics are cheaper than prescription medications.  If the doctor says ‘no,’ ask if there is “an older, cheaper, drug for the same condition,” she adds.  

“If he says ‘no,’ again and adds that a newer drug is better than an older one for the same condition, ask: ‘How do you know?  What’s the study of this?”  Given that drug companies fund medical studies, you also might want to ask who paid for the study of comparative effectiveness of the older and newer drugs that your doctor cites.  And if he still resists giving you an answer, go to another doctor.” 

Angell also suggested lobbying lawmakers to let Medicare negotiate the lowest 

prices and lobby FDA to change its prescription drug rules.  The only thing that could make lawmakers stand up to the companies and their campaign contributions is if they feared retribution at the ballot box from outraged consumers, Angell notes.  

Angell said consumers should lobby FDA to get it to require comparative testing of a new drug’s effectiveness versus an older drug, and not a placebo, which is a sugar pill.  Comparing placebos with new drugs gives the companies an incentive to develop the “me-too” drugs that really aren’t much better, if at all, than the older cheaper medications they replace, Angell says.  If the companies suddenly had to do comparative studies, the “me-too” drugs would dry up, she contends.  

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