PUSH Post
Public United for Savings in Healthcare
Big Pharma blues
What is "Big Pharma"?
"Big Pharma" is the collective name
for a small group of pharmaceutical
business houses - about 20 in
number - that dominate the drugs
and pharmaceutical scene globally.
Being businesses, they place profit
before all else, including the best
interests of patients.
Health care costs keep rising
endlessly. The expenditure on
drugs is irksome, particularly when
viewed against the background of
enormous profits that the
pharmaceutical industry reports
year after year. The industry is
entirely in private hands;
governmental efforts have been
abandoned everywhere. Being
businesses, profits boil down to the
common axiom: size matters.
Driven by mergers and acquisitions
(evidenced by the concatenated
and hyphenated names), the
industry is dominated by a group
of around 20 companies,
collectively known as "Big Pharma".
Big Pharma's sensitivity to patient
and customer concerns has been
scrutinized in recent years and
found to be distressingly callous.
Their dealings are seldom open or
transparent: murkiness, deception
and unwholesome nexuses abound.
The doctor-pharma nexus
The heavy hand of Big
Pharma
The heavy (other) hand ...
Pharm Free - Revenge of
the Jedi
Much more at:
About the biggest in the business world
Profits or profiteering
Despite claims of being a
high-risk business, the
industry reports huge
profits year after year. It
remains firmly entrenched
in the #1 spot for profits
returned on revenues
(almost 20%), a figure
that is 6 times the average
for big business as a whole.
Industry exaggerates costs of drug
development
New drug
discovery
costs us So you say!
big money
Several reasons are offered to justify the
need for these large profits, most of
which do not bear up to careful
examination.
"New drug discovery is an expensive
affair." The industry claims that it takes
about 800 million to a billion US dollars
for each drug that is brought to market.
On close inspection, the argument fails to
hold up.
© Dr Arjun Rajagopalan
25 October 2008
• Sales > 2 billion/ year
• Transnational operations
• R & D in at least 5 different
therapeutic areas
• Fully vertically integrated
operations
• The top 20 Big Pharma
companies represent almost 60%
of the world pharma market.
Source: Michael Rosen, June 13,
2005.
http://wistechnology.com/articles/1903/
•A large portion of this amount is spent
on expensive, barely ethical, drug
promotion rather than research. Besides
samples of drugs, small gifts are almost
always passed across the table: pens,
note pads, calendars and other gee gaws.
It does not stop here. Trips are sponsored
for conferences and updates, most of
which are obvious junkets.
•Most often, the basic research on a
compound is done by government-funded
research efforts. The pharma industry
takes over when it senses something
likely to be profitable. It is seldom
interested in drugs that are useful for
rare (orphan) diseases or those that are
seen mainly in poor countries of the
developing world.
•So called "new" drugs are often mere
extensions of existing compounds. This
prolongs the patent protection benefits
and allows high costs to be maintained
with dubious benefit to the patient.
Quite clearly, Big Pharma's profits are
unpalatable.
25 October 2008

The doctor-pharma nexus

"Doctors no less than
their patients are
being led along by
Big Pharma.
Research is
sponsored by Big
Pharma, and only
now are these
funding sources
mentioned in scientific journals alongside
findings. Conferences, seminars, calendars, pads,
pens, clipboards, anatomical diagrams, plastic
replicas of organs – and even the Friday
afternoon staff pizza – are being paid for by Big
Pharma." ... "What is the value of empowerment
when one is provided a few highly selective facts
in a gauzy, feel good frame? One remembers the
emotion and the drug name, and probably little
else."
Below the Fold: Pitching Prescriptions and Patient
Empowerment. Michael Blim. July 30, 2007
http://3quarksdaily.blogs.com/3quarksdaily/2007/07/below-
the-fol-1.html
"Their power, in relation to all of the forces that
might oppose their will, is so disproportionately
huge that they can dictate how they are to be
(lightly) regulated, shape much of the medical
research agenda, spin the findings in their favor,
conceal incriminating data, co-opt their potential
critics, and insidiously colonize both our doctors'
minds and our own". Talking Back to Prozac. By
Frederick C. Crews. The New York Review of Books.
Volume 54, Number 19 · December 6, 2007.
Financial ties and concordance between results and
conclusions in meta-analyses: retrospective cohort
study. Veronica Yank, Drummond Rennie, Lisa A Bero.
BMJ 2007;335:1202-1205 (8 December)
http://www.bmj.com/cgi/content/full/335/7631/1202?rss=1
Objective: To determine whether financial ties to one
drug company are associated with favourable results or
conclusions.
Conclusion: ... are not associated with favourable
results but are associated with favourable conclusions.
Machiavelian tactics
Big Pharma's reach is Orwellian. Its
power penetrates areas that should
be immune to the machinations of
the industry. The very mechanisms
that are in place to control it are
infiltrated by its overwhelming
financial clout. Horror stories are
legion.
Advances in Medicine are reported
and criticised in peer-reviewed
journals, believed to be
unncorruptible guardians of scientific
truth. These journals need
advertising support to remain
financially viable. Pharma houses are
the main advertisers and have been
shown to use this leverage to their
advantage. Positioning of ads next to
favorable reports, ordering "reprints"
in bulk, and taking subscriptions on
behalf of doctors are some of the
common methods by which Big
Pharma keeps medical publishing
beholden to itself. In recent years,
more vicious practices have been
brought to light. In one memorable
instance, a leading specialist journal
was asked to refrain from publishing
an article that showed little or no
benefit from the use of a widely
prescribed drug. The makers of the
drug were the largest advertisers in
the journal and they threatened to
pull out their advertising if the article
ran. The editorial board buckled and
held the article back. This shameful
behavior was "leaked" to an eminent
medical editor who ensured that the
conduct of the pharma house
received worldwide coverage.
Big Pharma commonly chooses to
be economical with the truth.
Nothing demonstrates this
behavior as dramatically as the
recently published article on the
efficacy of Prozac (fluoxetine) - the
widely prescribed drug for the
treatment of depression.
The authors of this study - a first-
of-its-kind analysis - obtained a
full set of trial data from the Food
and Drug Administration for four
antidepressants under freedom of
information rules. The study
included results from clinical trials
that the manufacturers chose not
to publish at the time. The trials
compared the effect on patients
taking the drugs with those given
a placebo or sugar pill.
When the data was put together, it
appeared that patients had
improved - but those on placebo
improved just as much as those on
the drugs. The authors conclude:
"... we find the overall effect of
new-generation antidepressant
medication is below recommended
criteria for clinical significance ..."
Prozac - a "blockbuster" drug for
its manufacturer - accounts for
almost a quarter of the revenues
of this 10-billion-dollar Big Pharma
house. Since its launch in 1988,
close to 40 million people have
taken Prozac.
Source: Kirsch I, Deacon BJ,
Huedo-Medina TB, et al. (2008)
Initial severity and antidepressant
benefits: A meta-analysis of data
submitted to the Food and Drug
Administration. PLoS Med 5(2):
e45. doi:10.1371/journal.pmed.
0050045

PharmFREE

This one is reminiscent of the first
Star Wars movie: the one where the
good guys have been driven to a
remote, god-forsaken place in the
galaxy by the all pervading power of
The Empire. The story starts with the
avowed ideals of the medical
profession "being threatened by the
lavish trips, gifts, and fancy meals that pharmaceutical
companies were providing doctors to change their prescribing
habits." The initiative described in this article is akin to Luke
Skywalker being mentored by Ben Kanobi. "Pharm Free" is the
light sabre that the good Jedi are distributing to medical
students and other early entrants into Medicine. It is an
educational campaign that is "...encouraging all physicians-in-
training and health-care providers to seek out evidence-based
and unbiased sources of information, rather than relying on
industry personnel for education.
"Vision: [Pharm FREE] "envisions a day when pharmaceutical
companies are able to dedicate their resources to creating
drugs that physicians choose to use because they are effective
in treating disease, not because they are effectively marketed.
We envision a day when every medical student and physician is
aware of the professional, ethical and practical complications of
the current relationship with pharmaceutical company
representatives. We envision a day when physicians demand
integrity, honesty, and education (not biased information) from
members of their profession, for the sake of our patients and
their trust in us."

© Dr Arjun Rajagopalan