Prescription Games: Money, Ego and Power Inside the Global Pharmaceutical Industry
By Jeffrey Robinson
Simon & Schuster, 2001
343 pages $45 (hb)
REVIEW BY PHIL SHANNON
http://www.greenleft.org.au/node/24865
Up there with the banks in the sheer unadulterated greed stakes would have to be the pharmaceutical corporations. For overpriced drugs, or no drugs at all for those too poor to afford them, the drug industry earns the rightly indignant wrath of people the world over. Jeffrey Robinson dispenses a hearty dose of wrath in this book on an industry which has ranked first or second in the list of the most profitable industries for over 30 of the last 40 years and which treats sick people as simply the means to the end of corporate profits.
The "tyranny of the bottom line" not social need determines what drug is manufactured and at what price. Commercial pressures drive the production of "drugs that sell well rather than drugs that are needed", Robinson notes. Research and development (R&D) is channelled into the search for the "block buster" drug that will keep investors happy and share prices up.
Research on less profitable drugs is stymied. If there are not enough sufferers from the more rare diseases, for example, drugs will not be developed because the market is too small. Other illnesses which are not "cost-effective" for drug research are anything but rare. There is little happening from the commercial drug companies to treat the epidemic diseases that plague developing countries because of the lack of purchasing power of the sufferers. Annually, US$27 billion is invested in drug R&D and, as with any capitalist investment, it goes to where the market return is. Advanced sleeping sickness kills 150,000 people a year yet there is only one drug, developed 70 years ago, for the disease — and it kills 5% of its users and is powerless against a new drug-resistant strain of the disease.
Malaria affects 500 million people in the Third World, yet there has only been one anti-malaria drug developed by a drug company in the last 40 years and that has been developed, not for those 500 million, but for mainly Western holiday, business and military travellers.
If you suffer from "erectile dysfunction", you will have a drug made for you. If you suffer from malaria, measles or tuberculosis you will probably die.
For those drugs that do make it to the light of corporate day, prices are grossly inflated to three to four times greater than the cost to produce them. The greed is naked. When Johnson & Johnson discovered that their anti-worm treatment for sheep could be used for colon cancer in humans, the price shot up from 6 cents per pill to $6.
High prices are maintained by patents which give a time-limited monopoly for commercial exploitation to the discoverer or inventor. Patents are justified by capitalists as a means to reward the risky business of invention, but they are really no more than a "license for extortion".
Pharmaceutical companies regularly lobby US Congress to extend the life of patents. The US, under President George Bush senior, easily persuaded the World Trade Organisation to extend the average period of drug patent protection from 17 to 20 years. Eli Lilley's Prozac, with sales of $7 million a day, was amongst the monster beneficiaries. Thank you very much, Mr President (who coincidentally was a board member and stockholder of Eli Lilley).
The US flexes its economic and political muscle in other ways to keep US-based drug companies supplied with their profit fix. In Thailand, the US drug company Pfizer manufactured an exorbitantly priced drug to treat AIDS-related meningitis. When two Thai companies produced a bio-equivalent drug at one-third the price, Pfizer complained to its political protectors. After the US trade representatives threatened to tax Thai imports into the US if the "copycat patent-violators" were not shut down, Pfizer's monopoly was restored.
The pharmaceutical companies' political influence extends to the senior bureaucrats in government regulatory agencies. In the US Food and Drug Administration, medical professionals with quaint allegiances to scientific integrity over commercial imperatives have been overridden by senior bureaucrats. Against the advice of medical staff, the FDA approved a Warner-Lambert diabetes drug which became one of the top 10 fastest selling drugs in the late 1990s. Only after 63 deaths from liver failure, whistle-blowing by an FDA medical officer and evidence of a cover-up of liver toxicity during the drug's clinical trials, did the FDA pull the drug off the market.
Governments come to the profit party in many ways. Taxpayers' dollars fund most basic drug research in universities or other publicly funded institutions. This research is then handed over to the drug companies which also receive generous R&D tax concessions. Forty-five of the top 50 selling drugs in the world were discovered, developed or tested with public money. Corporate welfare is all about raiding "the public feedbox".
Drug companies are quick to point out that their eyes are on more than the profit prize, citing their drug donations to poor countries. Philanthropy is certainly good for short-term PR, but it has clear limits. When a maverick CEO at Merck pushed through the development of a drug for onchocerciasis (river blindness), a parasitic disease affecting millions in west Africa, the investment community was upset and punished the company. They expected the corporation to be in the business of profits not charity. The last thing investors want is the alarming precedent of "giving away drugs to people who needed them".
Pharmaceutical companies provide a demonstration of the oxymoronic nature of "business ethics". Clinical trials are conducted by the companies which have an interest in getting the results they want. Non-steroidal anti-inflammatory drugs, for example, may be tested on young people because they show fewer side effects than the target population of aged people. They are hardly ever tested against cheaper drugs like aspirin because if they were found to be no more effective, consumers would not pay the higher price.
Drug companies also pay medical practitioners on a per patient basis to prescribe drugs in clinical trials. These payments can be as high as $5000 a patient and can distort doctors' loyalty to their patients. Patients without the condition the drug is related to have been tested on, exposing them to unnecessary side effects. Patients with the condition can be placed at risk by continuing with an experimental drug when an established drug would be more effective.
Drug companies have also turned academia into a virtual subsidiary. Researchers in fund-strapped higher education systems readily tap into any rich vein of funding. In 1995-6, more than 90% of all favourable articles published about tests of a calcium channel-blocker were written by authors who had financial links with the company manufacturing the drug. When drug company money comes in the door, scientific objectivity flies out the window.
When we move from R&D to marketing, the drug companies go from bad to worse. Advertising has traditionally been restricted to medical journals but there the ads are "rarely accurate, usually dishonest". In the US, direct to consumer advertising (DCTA) has also been recently allowed. The result is a boom in sales as more people are stampeded into more doctor consultations to request an advertised drug. Since DCTA was introduced in 1997 in the US, market growth has soared by 12% per annum compared to Europe's 5%.
The biggest promotion and marketing tool of the drug companies remains the sales representatives who visit doctors bearing gifts, from coffee mugs to junkets in beach-side hotels cloaked as government-endorsed continuing medical education. One of the more blatant sales bribes was the frequent flyer program for a hypertension drug: 50 scripts for it and the doctor got a round-trip air ticket to anywhere in the US.
Doctors who prefer to prescribe on the basis of science rather than the hard-sell call for special treatment. One drug company got a sales rep past the door of a difficult doctor by having a rep posing as a patient with a short skirt, frilly blouse, big hair and Colgate smile. Sex can sell where all else fails. The last laugh is had by the drug companies because the cost of each freebie is passed on to consumers in higher prices.
With its price madness and enormous waste (more is spent on promotion to secure market share than on R&D which could deliver affordable drugs to all who need them), the capitalist pharmaceutical industry is enough to make you sick.