Monday, March 11, 2013

Highest Goal of Big Pharma: To Be Sure You Are "Sick" Or, At Least, Think You Are

73 year-old Bob Aronson received a new heart on August 21, 2007, at the Mayo Clinic in Jacksonville, Florida. All these years later he has a very active, happy and loving life. He is on Medicare, has supplemental insurance and also participates in Medicare Part D, the prescription drug program.

Bob established and operates a great Facebook group “Organ Transplant Initiative.” He also has a website  and a blog on WordPress, “Bob’s Newheart.” (Don't you love the title?)

He also re-started “The Aronson Communications Group,” which includes three expert colleagues.

Both his age and his status as a transplant recipient cause him to take several expensive drugs. While anti-rejection drugs and others for blood pressure are fully covered by Medicare, COPD and thyroid are not.

These drugs are costly. I'll let Bob explain ...

"They are expensive, very expensive and while in the so-called 'Donut hole' we have paid nearly $1,000 a month so the price of prescription drugs is a big issue in our home. Upon passage of the affordable care act the cost was cut in half but $500 a month is still a lot of money. That’s my lead in to this question."

"Will someone please offer a reasonable, understandable and clear explanation as to why Medicare is not allowed by law to negotiate the price of drugs? I have researched this issue for hours and can’t find a simple explanation. There are a lot of convoluted, rambling excuses but not a clear reason.

"Here’s an example of the reasoning Pharmaceutical companies use for their opposition to allowing Medicare to negotiate the price of drugs (like the Veterans Administration does). 'Federal price negotiations would represent a policy change carrying significant risks for research and development investment in new and improved medicines. A substantial body of research shows that similar federal drug programs impose prices substantially lower than those negotiated in the private sector, and that such lower prices inevitably will reduce research and investment in new and improved medicines. This slowdown in pharmaceutical innovation will yield highly adverse effects upon future patients in terms of reduced life expectancies.'”

(Bob Aronson, "Bob's NewHeart")

And, Bob finds himself struggling with the most simple, yet the most horrifying conclusion:

"The primary goal of the worldwide pharmaceutical system
is to make sure we either are sick or think we are sick.
Consider this, they don’t make a dime on dead or well people
so making us sick or having us believe we are sick
is good for business."

Big Pharma is a huge part of a broken U.S. healthcare system. We spend huge amounts of money on healthcare — a staggering $2.7 trillion in 2011 (more on health care than any country worldwide) with no reductions in sight — and do not have as much to show for it as we should. The United States ranks 50th in the world in average life expectancy, below most developed nations.We spend $8,000 per capita on healthcare while the rest of the developed world spends $3,000, but our population is not nearly as healthy. And 75% of our spending is on chronic diseases that could be prevented.

(Matthew Heineman and Susan Froemke, Escape Fire, CNN Documentary, 2012)

Aronson asks you to consider all the syndromes we hear about: restless legs, carpal tunnel syndrome, cervical syndrome, chediak-higashi syndrome, chinese restaurant syndromeonder chronic fatigue immune dysfunction syndrome, churg-strauss syndrome, conn’s syndrome, cornelia de lange syndrome and costochondral syndrome…and this is a short list.

All of those syndromes, real or imagined, are treated by some sort of expensive medication. Pharmaceutical companies love syndromes and discover them with great regularity so they can convince physicians to diagnose them and then prescribe for the malady.

Why are Big Pharma's latest innovations designed to treat new syndromes and disorders? Or, more specifically, initiatives to market existing drugs for these bizarre afflictions? It’s known as disease-mongering, and it’s the reason the pharmaceutical industry currently spends more on advertising than they do on research and development.

You must understand that staying profitable and pleasing shareholders means constant innovation, but the FDA approval process for a new drug can take over a decade to complete and the cost can exceed $800 million. From there, on average, only five of every 5000 will make it to market. And there’s no guarantee any of those five will turn a profit.

Since syndromes are defined by symptoms rather than pathological processes, the old “reverse-placebo effect” can stimulate sales almost immediately. Consumers hear a roll call of symptoms and become convinced they’ve got them, whatever they are. That’s why, these days, RLS “affects” nearly 12 million people in the United States alone.

(Justin Rohrlich, "Big Pharma Wants To Make You Sick," Minyanville Media, March 24 2008)

Steven Woloshin and Lisa M. Schwartz of the Dartmouth Medical School had this to say on the matter:

“Helping sick people get treatment is a good thing. Convincing healthy people that they are sick is not. Sick people stand to benefit from treatment, but healthy people may only get hurt: they get labeled “sick,” may become anxious about their condition, and, if they are treated, may experience side effects that overwhelm any potential benefit.”
For more than a century pharmaceutical companies have created and enjoyed a lucrative monopoly on health care in America. They've done this by forming unholy alliances with those inside and outside of government: doctors, politicians, and scientists. Big Pharma's questionable and unethical practices pervade an industry that is meant to keep people healthy.

The Avaaz Team ("Big Pharma: a Sick Industry,", December 2012) listed a few of the dangerous trends at play in the pharmaceutical drug business:

* Lots of marketing, less research

"Big pharma justifies the high prices it charges for medicine with the argument that the prices sustain expensive and innovative research and development operations – even as the rate of R&D breakthroughs has plummeted and companies have slashed their R&D workforces.

"But, in the US, the industry is thought to spend almost twice as much on marketing as it does on R&D. Academics estimated that the industry spent $57.5 billion promoting their drugs in 2004, mainly by pushing them to doctors, or about $61,000 per physician. That's a full 24.4% of US sales revenue, as opposed to just 13.4% spent on R&D.

"Pharmaceutical companies often lavish doctors with free conferences, meals and drug samples – all of which are designed to make a doctor more likely to prescribe their product. And studies show this money works. On top of that, companies actually buy prescription records from pharmacies so they can individually track doctor's prescription records – and use this to tailor their marketing and promotion to the doctor."

* Bury the data

"To get their drugs approved by regulators, and to persuade doctors to prescribe them, big pharmaceutical companies rely heavily on clinical trials. This creates serious problems for consumers.

"To begin with, published trials funded by pharmaceutical companies are more likely to be favorable to the sponsor than other studies. This usually isn't because they are rigging the results – it's because they only publish the trials that suit them.

"Dr. Ben Goldacre describes how it works with a personal recollection in his recent book, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients:
'Seven trials had been conducted comparing reboxetine against a placebo. Only one ... had a neat, positive result, and that one was published in an academic journal, for doctors and researchers to read. But six more trials were conducted, in almost 10 times as many patients. All of them showed that reboxetine was no better than a dummy sugar pill. None of these trials was published ...'
"With between two-thirds and three-quarters of trials published in major medical journals funded by the industry, this is a major problem.

"And it gets worse. Many drug companies conduct their testing in developing countries where regulations are poor – and sometimes the people they experiment on die in the process."

* Finding new users

"Learning new ways to market old drugs is one of the industry's favourite tricks. Take the case of powerful antipsychotic drugs designed to treat schizophrenia and bipolar disorder that are now routinely prescribed to treat mild mood disorders, insomnia and emotional discomfort. Two antipsychotic drugs are now the fifth and sixth best-selling prescription drugs in the US: 3.1 million Americans regularly use an antipsychotic medication.

"A UK government review found that 1,800 people died needlessly in nursing homes due to the overuse of antipsychotics on dementia patients. As usual, this over-prescription didn't just happen. In the US, Johnson & Johnson reportedly reached a $2.2 billion settlement with the government after it was caught paying tens of millions in kickbacks to medical professionals to increase sales of its drugs in nursing homes, including over $100m in antipsychotic drugs.

"Quick growth in the use of drugs to treat new conditions generally involves "off-label" use – using a drug to treat a condition federal regulators have not approved it for. Companies are not allowed to market their drugs for these purposes – but they don't always follow the rules. In the largest settlement ever for the industry, GlaxoSmithKline agreed to pay a $3 billion fine for marketing its antidepressants for use as a weight loss aid and to treat sexual dysfunction. But the company cashed in tens of billions selling these drugs – making the fine little more than an additional business cost."

(Sources: New York Times, Guardian, Nature, PLOS Medicine, Journal of Continuing Education in the Health Professions, Journal of General Internal Medicine, Health Affairs, British Medical Journal, EATG, Prevent Disease, Biomet, BBC, Bad Science, Guardian, Boston Herald, World Health Organization, CNN, Washington Post)

In Closing

Bob, I hope in all of this mess, you can find "a reasonable, understandable and clear explanation as to why Medicare is not allowed by law to negotiate the price of drugs." In its present state, the American medical system is so full of holes, it may be symbolized as "Swiss cheese." Let's keep working to effect needed change if not for those today, for those in future generations. The level of my frustration with Big Pharma is enough to make me sick... and, I guess, that is exactly what they want to do. The truth is "a hard pill to swallow."


1 comment:

Anonymous said...

I think you're right on the mark with this one. I'm a nurse on an impatient psychiatric unit. I'm happy to say our patient's are only prescribed essential medications. And highly addictive meds are used only during the acute stage of their illness. But in the past I have had patient's call after discharge to say they could not get their prescription filled because it was too expensive. Some are as much as $400-700.00 for a 30 day supply. We now have a system in place where the type of insurance is printed on our census sheet. This way if a patient doesn't have prescription coverage or has a high co-pay they aren't started on medications they can't afford. It doesn't help the big problem but at least we can do our part one patient at a time. Whenever possible our doctors try to use medications that are available from the "big box" stores for $4 a month.