Cindi Davis ENG120

Has the Pharmaceutical Industry Played a Role in Americas Health Decline?

I always get the large parties at work, and this night was no different. A group of physicians were coming to watch a presentation where they would not only get informed about the latest and greatest medicinal marvel, but also get served delicious French food by me. The pharm dinners are all alike; a speaker touts his or her drug, the doctors listen half-heartedly, and ask a few generic questions to feign interest. Why do they even bother? I wondered. With the exception of marvelous food, why would any busy physician waste 3 hours of their evening to hear about a drug when they already have so many to choose from? A few took notes, obviously interested in something they heard, but most remained silent while they ate, looking as if they were hearing it for the billionth time. I wondered how unbiased the information was, after all, the representative was there to market the drug. At first it seemed the drug rep was quite educated in medicine, but I then found out that the speaker was a doctor, and it made sense how he knew so many medical terms. Then it hit me: How did he become any more of an expert than the colleagues he was teaching? My curiosity was piqued so I researched the topic. The main revelation I learned was that these same busy doctors are getting influenced by these companies. They were receiving money and gifts to hype these drugs! This sparked a bit of crossness in me. Not only do these pharmaceutical companies spend billions advertising to the poor uneducated consumer, who in my opinion do not need such information, but they give the doctors gifts to prescribe their drugs? As my wheels churned at the domino effect I was imagining, I decided to see if what I feared was possible.

The pharmaceutical industry, hereafter referred to as Big Pharma, is made up of the drug manufacturers, researchers, and its trade and lobbying groups. They are the ones who research, formulate, produce, and sell all prescription drugs here in the United States. Since the late 1900s, what we consider the modern era of the pharmaceutical industry has led to the discovery and development of all the medicines we know and use today. (Dailey, par. 1) This evolution and development is vital in the control and elimination of disease around the world. Big Pharma is important and helps to save and improve lives; however, Id like to show that with their greed and self-centeredness the organization has managed to also damage the health of American citizens, and continues to do so today. They have placed their need for financial success over the need to serve the public health, and have been quite blatant about it until now. The fact that doctors and drug manufacturers no longer make money when they get people well has caused a large portion of the medical community to sacrifice morals for dollars. They utilize methods that are deplorable, and even alter test reports to produce predetermined outcomes that will put their products in the best light. Lets take a look at how the pharmaceutical industry has played a giant role in the deterioration of Americans health by direct-to-consumer advertising, industry funds directed at physicians, and even creating new diseases. Do you know what the United States has solely in common with New Zealand? They are the only two countries in the developed world that allow direct-to-consumer marketing of pharmaceutical drugs (Woodard, par. 5). Since the FDA facilitated broadcast advertising for drugs in 1997, consumers are inundated with information and testimonies about drugs that should be reserved for the medical community only. Doctors reported prescribing the advertised drug in 39 percent of their direct-to-consumer advertising visits, even though 48 percent of them admitted another drug would be just as effective (Weissman, et al. par. 1).

Not only do advertisements lead to the over-prescription of drugs, but also to the earlyprescription of a drug that needs more testing. Vioxx is an excellent example of possible negative effects of marketing a new drug: Vioxx was an anti-inflammatory used primarily to treat arthritis. It was aggressively marketed with over $100 million in promotion that featured Olympians Dorothy Hammill and Bruce Jenner. It became widely known and prescribed before being pulled off the market for doubling risk for a heart attack or stroke, but not before being prescribed to millions of people. The FDA estimates that Vioxx was responsible for as many as 139,000 heart attacks and almost 30,000 deaths from heart attack or stroke. (Woodard, par. 9) So, we see that direct-to-consumer marketing is prohibited all over most of the world for some very good reasons. We must then take a look at the representatives trying to sell these products to the people who can actually prescribe them to these now-informed consumers. At its peak, in 2007, the American pharmaceutical industry employed 102,000 sales reps, making constant visits to the countrys approximately 661,400 doctors. (Staff, par. 8) At first the scenario seems natural; after all, the doctors need to know about the drugs they prescribe. But if we study the phenomena a bit, we realize that it is a physicians job to be educated about what they prescribe, and it is a drug reps job to make sure their products look better than the competition. In order for the representatives to make their drugs stand out, they often offer the physicians gifts, such as free samples, pens, memo pads, meals, tickets to ball games, and even free trips. The cost of these offerings is calculated into the companys marketing budget. Along with these tokens of future appreciation, these pharmaceutical firms often pay doctors to speak on behalf of their products. These investments net enormous returns. For an estimated $20 billion a year spent on marketing to physicians, they stimulate drug sales that top $300 billion (Staff, par. 17). According to an article in the Journal of the American Medical Association, Dr. Ashley Wazana

of McGill University in Montreal named another benefit of these perks: Accepting a free trip to a drug-company-sponsored conference guided doctors to write more prescriptions of the companys drugs, a spike of 80 to 190 percent (Staff, par. 20). So we see just how one hand is washing the other in this instance. But where is the patient in this scenario? We also find that these pharmaceutical companies do prescription tracking, or datamining. This means they track doctors and their prescription habits, and market accordingly (Rhee, par. 9). Subsequently, not only do they study the physicians and their different personalities and styles to market differently to each one, but they give more gifts to the practices that prescribe more of their drugs. Furthermore, according to Dr. Wazana, Interactions with pharmaceutical representatives were also found to impact the prescribing practice of residents and physicians in terms of prescribing cost, non-rational prescribing, awareness, preference and rapid prescribing of new drugs, and decreased prescribing of generic drugs. (qtd. in Rhee, par. 15) All of these effects are negative ones for the patient. Now we see that billions are needlessly spent on advertising (which, by the way, does not equal educating) pharmaceuticals to both doctor and patient, but the most disconcerting atrocity could be the new diseases being created by these drug giants. Labeled disease mongering by critics, it is simply the pharmaceutical companies way to scare the consumer into thinking a (often correctable) condition is actually a disease, and they need medication for it. One example of this ridiculous practice is the labeling of shyness as social phobia that requires pharmacological management ("Disease Mongering Debate: Do drug companies create diseases to sell
medicine?" par. 6). There are numerous examples, but the one I found utterly appalling is female

sexual dysfunction. Since the release of Viagra in 1998, Big Pharma has worked diligently to create a market for pink Viagra. It created the term Female Sexual Dysfunction (FSD) as

something comparable to Erectile Dysfunction in men (Lerman, par. 9). The perplexity arises when we consider what medicalizing sex to treat one aspect, the biological one, will do. Medicalizing sex will brand sex as a consumer good, with doctors as the retail outlet. It will also shift from treating couples for sexual problems to treating the individual (Benuto, par. 3), which, in the case of sexual dysfunction, is self-defeating because sex is typically not a solo event. Of course, there is no company out there that doesnt have some positive qualities, and the pharmaceutical industry is no different. Pharmaceutical companies play a vital role in the research and development of medications. They invest in and at times advance important medical discoveries. They provide medications to millions of patients in efforts to alleviate pain, improve quality of life and promote health. (Rhee, par. 22) So now we should look at evidence of how Big Pharma can help us. First, pharmaceutical companies believe that advertising directly to consumers is helpful because it educates people. Education about anything, if it is truthful, is vital to comprehension. They deduce that patients will ask more thoughtful questions and be more aware of possible treatments after watching their ads (FDA, par. 6). Asking questions to medical personnel is the only way patients can understand their health and what they need to do to maintain it. Another benefit they state is that it could also remind someone already on the medication to take their pills (Wright, par. 2). According to Big Pharma, watching an advertisement for a drug could even remind them to visit their physician, which can sometimes be a lifesaver. We also have a place in the industry for well-trained pharmaceutical reps. Doctors cannot be expected to obtain all the information on all the new drugs on their own; they need someone with knowledge to instruct them. Pharmaceutical Research and Manufacturers of America President and CEO John J. Castellani believes that without interaction with company

representatives, some healthcare professionals would find it more difficult to obtain up-to-date, accurate information available regarding prescription medicines. In fact in a telephone survey of more than 500 American Medical Association members, more than 90 percent said that interactions with representatives allow them to learn about new indications for approved medicines, potential side effects of medicines, and both emerging benefits and risks of medicines ("New Survey Emphasizes Value of Biopharmaceutical Company Engagement With Healthcare
Providers." par. 6).

An opposing view to the disease-mongering accusations of Big Pharma critics is the one of disease awareness. This view claims that by introducing the idea of a disease to people, they may get early treatment and possibly save themselves future problems. Pharmaceutical companies feel that some patients would suffer in silence if they were not exposed to their valuable advertising material. For example, before erectile dysfunction became a widely known disease and Viagra was available to fix it, men had to resort to such measures as penile injections and suppositories (Benuto, par. 2). While there may be slight truth to educating consumers about potential drugs, there most certainly has to be more unbiased information available that these consumers need. According to a FDA survey of 500 physicians, 75 percent of them stated they felt direct-to-consumer ads caused patients to think the drug works better than it does, while minimizing the risks (FDA, par. 6). Doctors have an obligation to gauge their patients knowledge, and provide extra information to those they feel are not aware of everything, not drug companies. They should also be the ones to reminding their patients of an appointment. Instead of watching a drug commercial to be reminded about medication intervals, doctors could suggest a timer/alarm of some sort for their forgetful patients.

Do physicians genuinely need salesmen to educate them? What kind of education are these doctors actually getting? These representatives are anything but objective about their products. According to Shahram Ahari, an ex-pharmaceutical representative who spent two years selling Prozac and Zypraxa for Eli Lily, Drug companies like hiring former cheerleaders and ex-models, as well as former athletes and members of the military, many of whom have no background in science. (Baram, par. 3) The representatives have been trained to sell, and sometimes that includes incomplete or inaccurate information (Rhee, par. 16). These physicians could become educated about all drugs they could potentially prescribe without having to rely on the unsound authentication of salesmen. In fact, Democrats in Congress are pushing for a bill to counter the pharmaceutical companies' sales campaigns by paying nurses, pharmacists and other health professionals to present objective academic literature on prescription drugs to doctors (Baram, par. 14). Also, as American consumers, do we genuinely believe that every single little condition that could arise in our lives could be resolved with a pill? Take Female Sexual Dysfunction for instance. Given that 30 percent of women suffer from low sexual desire, we cannot really even consider it abnormal, much less a disease needing medication (Benuto, par. 6). Mens erectile issues werent alleviated by the information advertised either; many men found Viagra did its job in the erection department, but their sexual problems still existed (Benuto, par. 2). That alone suggests the disease is not curable by pharmacological means alone. The industry practices of inventing new diseases to sell newly created drugs, lining physicians pockets, and commercials for medications on every station demonstrate that the pharmaceutical industry has undeniably played a huge role in the deterioration of American health. They have made us a nation of hypochondriac individuals who are convinced that a man

made pill will cure almost any of our ailments. Studies have shown that the advertisements of medications make consumers more likely to ask for that drug simply based on what they heard. In a survey of physicians by the American Medical Association, these advertisements fail to inform consumers properly of risks and benefits, therefore the patient misperceives the drug. (Weismann, et. al, par. 4) They also have shown that tokens of appreciation given to doctors do indeed influence their prescription habits (Staff, par. 20). Big Pharma is operating like this under the guise that they are doing it for the public good. They claim that the billions spent on marketing and advertising are not solely for profit, but to help anyone who may be suffering from anything. However the astronomical rate at which spending and selling have increased suggests otherwise, as do the profit margins of the major manufacturers. From marketing and selling untested, potentially dangerous drugs, to constantly creating new ones rather than perfect the old ones, the research substantiates that patient health is quite low on their list of priorities. While we do need the pharmaceutical industry and its beneficial contributions, there are alternate ways they could provide their services. The billions spent on advertising directly to consumers could be used to research drugs that cure disease, rather than aid symptoms of disease. The physicians could attend educational seminars and classes to learn about new medications, and they could learn from actual unbiased teachers instead of salesmen. Fortunately, this phenomenon has been recognized by several parts of the medical community, and gradually things are beginning to change. The number of pharmaceutical representatives is expected to drop by 25 percent soon as more doctors see reps by appointment only, or not at all (Staff, par. 8). Additionally, teaching hospitals and medical schools are starting

to limit contact between their students and any vendors, including drug companies and medical device makers (Staff, par. 9). Overall it would appear that the end is near for Big Pharma, as we know it at least. The gifts are being limited and eradicated, and doctors are aware that their information isnt 100 percent reliable. The industry has reached a point where it must change its tactics and objectives in order to subsist, and the indication is that it is moving in that direction.

Works Cited
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Feibelman. "Physicians Report On Patient Encounters Involving Direct- ToConsumer Advertising." bvsde.paho.org. 2004. Health Affairs. Web. 18 Apr 2012. Woodard, L. "Pharmaceutical Ads: Good or Bad for Consumers?" abcnews.go.com. 04 Feb 2010. Walt Disney Company. Web. 18 Apr 2012. Wright, D. "The risks and benefits of direct-to-consumer advertising of pharmaceuticals." huffingtonpost.com. 2010. Huffington Post. Web. 19 Apr 2012.