Many people would agree that there is a problem with over aggressive marketing
of prescription drugs. What is elusive is a solution. In the US, I suspect the
problem is worse, because drugs are even more expensive, for those under
patent, and the profit is greater.

Bill

Pushing Pills down our Throats
By Judy Gerstel
Sept 2, 2005

Chances are, if you're an adult Canadian, that you're taking a
prescription drug.

It could be a statin to lower bad cholesterol, an antidepressant to
raise spirits, a calcium channel blocker to lower blood pressure, an
erectile dysfunction drug to raise, er, ...

Last year, the cost of prescription drugs in Canada surpassed $18
billion.

That's a prodigious pile of pills.

It's also more than the payments for all services provided by all the
physicians in Canada last year.

And the annual increase in prescription spending in this country
â?" it's growing by $1.5 billion a year â?" would be enough
to finance the services of some 3,500 new physicians every year,
reports the Canadian Medical Association Journal.

Now that is hard to swallow.

And what's the explanation?

Are we getting sicker? Are we getting healthier? Or, are we simply
getting suckered more by Big Pharma ...

A compelling case for the latter is made in a new Canadian book titled
Selling Sickness: How The World's Biggest Pharmaceutical Companies Are
Turning Us All Into Patients.

Of course, author Alan Cassels, a drug policy researcher at the
University of Victoria, and coauthor Ray Moynihan, a health care policy
researcher and journalist, aren't exactly telling a new story.

Drug companies pandering to doctors and putting them on the payroll
while at the same time medicalizing lifestyle issues is an oft-told,
hoary tale.

Books have been written about disease-mongering and the sly marketing
of non-essential medicines.

One of the most influential was published last summer: The Truth About
the Drug Companies: How They Deceive Us and What To Do About It by Dr.
Marcia Angell, former editor of the New England Journal of Medicine.

Cassels and Moynihan, however, while not focussing on Canada and mostly
using U.S. dollar figures, include Canadian examples and resources and
note differences between this country and its neighbour.

Cassels warns in his introduction that Canada's universal public health
system "could be seriously undermined by the growing corporate
influence (of the pharmaceutical industry) ... a health system that
allows drug companies to play a role in defining who is sick," he
writes, "is fundamentally unhealthy."

As Wall Street knows, he emphasizes, "There's a lot of money to be made
telling healthy people they're sick."

The book devotes chapters to high cholesterol ("Selling to Everyone"),
depression, menopause, attention deficit disorder, high blood pressure,
pre-menstrual dysphoric disorder, social anxiety disorder,
osteoporosis, irritable bowel syndrome and female sexual dysfunction
â?" all of which have been (or, in the case of female sexual
dysfunction, are in the process of being) turned into cash cows for Big
Pharma.

Cassels and Moynihan take us behind the scenes, divulging strategies
and manipulation â?" "dirty tricks and covert operations" â?"
that cause a couple of disorders themselves: they make your skin crawl
and make the hair on the back of your neck stand up.

One is what Cassels calls "the backdoor form of advertising known as
`disease awareness' campaigns ..."

Another is bringing together panels of medical experts to alter the
guidelines and definitions of medical conditions to make them more
inclusive (thereby creating more patients and drug consumers) for
example, lowering the levels of cholesterol deemed necessary to qualify
for treatment.

Eight of the nine experts who wrote the latest cholesterol guidelines
also served as paid speakers, consultants or researchers to the world's
major drug companies, reports Cassels.

My favourite, egregious pharmaceutical ploy is referred to as
"astro-turfing"; creating fake "grass-roots" patient advocacy
associations to promote disease awareness.

In a phone conversation, Cassels says the book could have been three
times as long. "I could probably write a pharmaceutical scandal story a
day," he says. He cites the use of neuroleptics for elderly people
"anti-psychotic drugs used willy-nilly to zombify our grandparents";
and the "in-your-face lobbying to politicians by the (drug) industry."

He accuses the Arthritis Society in British Columbia of being a "de
facto marketing arm of Merck and Pfizer"(makers of Vioxx and Celebrex).

"We know that the industry bought credibility through the arthritis
society," he says. "But the science wasn't there and people were duped
big-time."

He also notes that a lot of the new patients taking Cox-2 drugs weren't
seniors, that the drug companies "partly had to remake arthritis from
being an older person's disease to something even a figure skater like
Dorothy Hamill would get."

And just as an aside, Cassels points out that British Columbians take a
lot fewer drugs than Ontarians. For example, he says, "We looked at
cholesterol-lowering and came across this bizarre thing where the per
capita rate for prescribing cholesterol-lowering drugs in Ontario is
twice what is in British Columbia."

The reason? "No one really knows, but the West coast might attract
people less likely to take drugs: the flaky, west coast thing, and
also, the marketing of drugs happens most intensely in central Canada
and the uptake is much faster and bigger in Ontario.

You are SO right. I lived in Canada (Alberta) for 20 years before
returning to the States. I was amazed when my doctors here suggested
taking me OFF many of the medications I was on in Canada. One of the
problems in Canada is the difficulty (especially in remote areas) of
getting the appropriate tests. You can't get an MRI unless you are
missing a limb at the very least. Another problem is the seeming lack of
knowledge by MDs. But they DO have a knowledge of drugs - usually the
older, least effective and most problematic drugs at that. If I had
stayed in Canada I would be dead.