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http://www.newint.org/issue362/peddling.htm

Big  Pharma / SKEWING THE MARKET

Selling cures for imaginary diseases is where the  drug industry really
rakes in the cash, argues Alan Cassels.  Real need barely enters the
picture.

Image Courtesy: www.adbusters.org

Thirty years ago  the British physician, Julian Tudor-Hart published his
famous inverse care law?: those  who most need medical care are the
least likely to get it.?

Modern  pharmaceutical research is playing Dr Hart?s law out on  a
macabre global scale. While the debilitating diseases of the poor ? such  
as malaria, tuberculosis and sleeping sickness ? have few or no  
treatments, the drug companies are busy working on cures for a
ballooning  set of made-up? diseases of the rich and privileged. There  
are now drugs for toenail fungus, pre-hypertension? and  bedwetting; for
compulsive shopping and gambling addiction?.  The yawning extremes
between the research priorities in our two worlds  get larger ? and
weirder.

Daniel  Berman used to work for Big Pharma and saw at firsthand how
companies  created markets? for new drugs. Now the Geneva-based
co-ordinator  with Mdecins Sans Fronti?res? Access to Essential  
Medicines Campaign, Berman describes the example of drugs being created  
to treat normal changes to the prostate that develop as men age.

It  used to be that when men age, they have to go to the bathroom during  
the night a couple times and that was considered a part of ageing,  and
that was no big deal. But this problem was turned into a disease  by the
drug manufacturer.? Because the company was developing a  drug to deal
with the condition?, they needed to convince  both doctors and patients
that this aspect of ageing required drug  treatment. And  they hired
people like Daniel Berman to help spin that message.

To create new? diseases Berman says drug companies hire  public
relations agencies and work with academics. You find a  professor
working in a university and fund that professor to write a  book, or to
do a media tour around the country. Or you find a public  figure, a
sports figure or an actor, to go around and meet and work with  
journalists, and to do work with public forums, so you literally create  
this need.?

Creating  a market that will reduce men?s nocturnal trips to the  
bathroom is what modern drug research is all about. Finding lifesaving  
treatments for poor customers can be left to the philanthropists. When  
drug company executives schmooze with investors, they talk about
diseases  in terms of market potential and how well a disease area
performs?.  Remarking on rising rates of obesity or diabetes, investors
and drug  makers can hardly contain their mutual glee. The dark clouds
of potentially  dire public health consequences are seen in terms of
their silver linings ? generating  legions of new customers. Drug
companies claim they need a large market  to recoup their research and
development costs. But the top drug companies  throw nearly three times
more money at marketing and promotion than they  do at basic R&D.

Who needs cures?
Many people still believe that medicine is a noble pursuit, dedicated  
to curing humankind?s ills. But the reality is that cure? is  pass.
According to Alex Hittle, a biotech analyst at AG Edwards  in St Louis:
We sometimes joke that when you?re doing  a clinical trial, there are
two possible disasters. The first disaster  is if you kill people. The
second disaster is if you cure them. The  truly good drugs are the ones
you can use chronically for a long, long  time.?

Over  the past decade we?ve seen the pharmacologizing of everyday  life
at a breathtaking pace ? the rampant and colonizing forces  of the drug
industry, sometimes slyly, sometimes overtly, reshaping the normal ups
and downs of everyday life and turning them into market opportunities.  
Among the range of invented or trivial conditions? for  healthy, paying
customers are male pattern baldness, wrinkles, unwanted facial  hair,
erectile dysfunction and persistent sadness (not to be confused  with
depression).

The  big money, however, is not in niche complaints that can get  
turned into diseases, but in taking risk factors for future  possible
diseases  and turning them into conditions that are targets for drug
treatment.  So lifestyle conditions common to our 21st century world ?
obesity,  cholesterol or high blood pressure ? become fair game.

This pharmacologization? of human health is an outgrowth  of
medicalization? which the late US author Lynn Payer  discussed in her
1992 book Disease Mongers. She wrote that more  benign ways of  
characterizing ordinary ailments (and simpler, less costly remedies)  
are ignored or marginalized when pharmaceutical manufacturers start  to
colonize an area of human health. In order to build demand for  their  
products and services they will sponsor awareness-raising campaigns  to
make common conditions look as severe and widespread as possible.

Two  of the best examples are the drug industry?s response  to blood
pressure and mental health.

The  antidepressant market is large and fluid. Everything from  
critically debilitating depression to mild anxiety could be  ripe for
medication.  Large companies, fiercely fighting for customers, are
constantly  seeking to expand the definition of depression and so
increase  the numbers  who need treatment. In such a milieu, tragic
events like 11  September 2001  are seen as marketing opportunities, as
excuses to flog more treatments for post traumatic stress disorder?.

Eli  Lilly, facing the end of its patented blockbuster, Prozac,  
recently relaunched the famous drug with a fancy new pink  makeover and
a nifty  name ? Sarafem. This Prozac in Pink? is now marketed  as a
treatment for severe PMS (now reshaped into the more medical-sounding  
PMDD ? Pre-Menstrual Dysphoric Disorder).

Drug  giant GlaxoSmithKline has taken paroxetine (Paxil in North  
America, Seroxat in Europe) and had it approved to  treat what  we used
to call  social phobia or shyness, now reclassified as social anxiety
disorder? (SAD).  Barry Brand, Paxil?s product director, told the
journal Advertising  Age: Every marketer?s dream is to find an
unidentified or  unknown market and develop it. That?s what we were able
to do with  social anxiety disorder.?1

The  creation of disease categories in psychiatry has not been  without
controversy. San Diego-based psychiatrist  Loren Mosher,  in his  letter
of resignation to the American Psychiatric Association,  said:
Psychiatrists  have become the minions of drug company promotions.? He
blasted  the drug-industry shaped definitions of mental disease: No
longer  do we seek to understand whole persons in their social contexts
? rather  we are there to realign our patients? neurotransmitters.?

Managing risk?
Disease prevention in healthy people with so-called risk factors? like  
high blood pressure or high cholesterol is another lucrative market.  
These measurable markers are carefully defined to encompass vast numbers  
of healthy people.

High  blood pressure medicalized? becomes hypertension?,  now the
leading pharmaceutically treated condition? in  the world. Of course
anti-hypertensive drugs do help people who have  high  blood pressure or
who have had a previous heart attack or stroke. But  the drugs get
pushed on healthier, younger people with very little  evidence as to
their impact on health or longevity.

In  1999 when the World Health Organization held meetings  to set
high-blood-pressure guidelines, Big Pharma  made sure their interests
were well represented.  What resulted were recommendations not based on
the best evidence,  but based on the best support for pharmaceutical
treatments.

Drug  companies also support patient groups or programmes  that are
warm to their interests such as the National  High Blood Pressure  
Education  Program in the US. Earlier this year this group sounded
warnings about pre-hypertension?,  which ratcheted down the definition
of high blood pressure from 140 over  90 to 120 over 80, thus turning
millions more people with borderline? high  blood pressure into
medication-needing patients overnight.

The  trend of big pharmaceutical companies morphing into  nothing more
than marketing organizations is reflected  in data from the  drug makers  
themselves. The Pharmaceutical Research and Manufacturers Association  
(PhRMA) in the US reports that, since 1995, R&D staff of US brand-name  
drug companies have decreased by 2 per cent, while marketing staff have  
increased by 59 per cent. Currently, 22 per cent of staff are employed  
in R&D, while 39 per cent are in marketing.2

And  the marketers are getting involved earlier in a drug?s development  
to make sure things turn out as profitable as possible. Kim White, the  
managing director of the New York office of Ogilvy Public Relations,
says that the pre-launch marketing strategies for many of the new
mass-market  medications will include company-funded education of
doctors and consumers  long before the drug is launched. The job of the
PR company, she says,  is to beat the drum?, to use conferences and
journals  to get doctors and consumers buzzing about a new drug coming  
down the pipe.3

Often,  patient groups or medical foundations ? so-called third-party?
organizations ? are  funded to participate in these campaigns, silently
orchestrated  by drug company marketing departments and their PR houses.

I?m reminded of Willie Sutton, who spent his career robbing banks,  
escaping from jail, only to rob again. When he was asked at the end of  
his career why he kept on robbing banks, his nonchalant reply was:
Because  that?s where the money is.? That could explain why drug
companies  spend so freely on marketing and disease mongering instead of
lifesaving  research.
Alan  Cassels is a drug policy researcher in Victoria, BC, Canada.  He
led a team of researchers which produced Canada?s first evaluation  of
the quality of media reporting of prescription drugs.

1 David  Goetzl in Advertising Age, 26 June 2000.
2 Deborah Socolar and Alan  Sager, Pharmaceutical marketing and research
spending:  the evidence does not support PhRMA?s claims?, Boston  
University School of Public Health.
3 Interview with author.