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Overview: Why call it bad Pharma?

I have conducted research surrounding the pharmaceutical industry. Although this industry has made breakthrough discoveries that have helped change the medical world in positive ways there is a side that is money hungry and extremely manipulative. Throughout this blog page I will hopefully show you a side of the pharmaceutical industry that you might have not known about before. I want to show how their power and influence has molded the attitudes and behaviors surrounding medicine in the United States.

The current system uses its power to influence the way doctors practice medicine and how patients accept care. It’s creating a medicalized society on the basis of marketing and cash flow. To put in perspective the industry in 2017 was worth $934.8 BILLION and in only expected to increase. The rate of that increase sits at about 6% and by 2021 the industry will be worth $1170 BILLION. To me an industry making that kind of money doesn’t have the best intentions all the time, so I wanted to further investigate its success.

I have learned through my research how the power of the industry has manipulated the legal, political, economical, environmental, and social structures in the United States.

Under these ever changing elements, healthcare market growth is boosting because:

Politically, legally and economically, representatives have reduced taxes and lowered drug prices in the USA for consumption

There are also lowered regulatory barriers for new drugs in the States as well

Environmentally and socially, population, aging and sedentary lifestyles are leading to an increase of chronic diseases prevalence

High urban pollution levels increasing specific conditions such as asthma

Also changes in the food causing diabetes, heart disease and cancer

All these elements hold a relationship with one another working together to keep the industry alive and making profits

Pills & Power

From my first critical review: Pills, Power, People: Sociological Understandings of the Pharmaceutical Industry, author Joan Busfield explains how the pharmacy industry’s power contributes to the construction of scientific facts. The three major problems that contribute to the abuse of prescription medication is 1.) pills are taken by people who can deal with their problems in other ways, 2.) pills are produced and prescribed in dosages that are too high and 3.) people take the pills for too long. This is all because the industry and our health providers tell us this is safe behavior. The reason this is getting so out of hand is the power the industry has over the construction of scientific facts about the drugs they’re selling.

The author refers to the book Science in Action (written by Bruno Latour) because it provides an analysis on how scientific facts are constructed. He describes fact making as a social process that is common in sociology and has nothing to do with the products of science (e.i. computers, DNA strand etc) but instead it is more concerned with examining ‘black boxes’. A ‘black box’ would be ‘science in the making’. Making science involves uncertainties, controversies and alliances between actors who work together to control research in labs, development of networks and the production/publication of scientific papers. The author uses Latour’s book to analyze the pre and post approval evaluation of drugs on the marker. From the article the Busfield (2006) writes “The industry’s power is not unregulated, an important source of it’s power is the control it exerts over the scientific fact making that underpins a drug’s evaluation.” (p.310).

Pre-approval

Research and development is paid for and controlled by Pharma itself

They choose how to carry out studies, select tests and how they present data

Allows Pharma to select information to support their case and hide information that will hurt them

Stems form economic power (15-16% of revenue towards research and development)

Normal time of development of a new drug = 10-15 years

Pharma has sped it up to 1-2 years

Post-approval

Gives factual status to the claims of safety and effectiveness

Usually aren’t questioned

Drugs are analyzed for intended purpose but also analyzed to see if it might be useful in treating conditions outside original intent to re-sell for profit

Also competing drug companies attempt to put out similar drugs

Busfield, J. (2006). Pills, Power, People: Sociological Understandings of the Pharmaceutical Industry. Sociology, 40(2), 297-314.

Sociology of diagnosis

Author Annemarie Jutel through her article wants to reflect how the sociology of diagnosis has a contemporary relevance to health policy, practices and outcomes of diseases. Furthermore, she wants to analyze how medicine has a relationship to diagnosis that relates to the further investigation of “diagnostic tension”. Diagnostic tension describes the turf war that occurs when trying to define a disease. Individuals and groups with varying interests scramble to establish the authenticity of their claims or expertise. These tensions exist between the lay person and medical representative. It can even exist within different health professional groups, policy markers and doctors, doctors and administrators etc.

In the case of naming a disease or condition, medicine is considered “temporally situated” and makes the diagnoses on the basis of technology and values available at that particular point in time. Diagnoses also come from individuals, professionals, or society modifying what they consider to be a problem or normal.

The relevance of the pharmaceutical industry in relation to diagnosis is that is acts as an engine of diagnosis. Pharmaceutical remedies hold power to a diagnosis, promote particular diagnoses, and sometimes even creates them. The industry has interests that specifically serve the creation and maintenance of certain diagnoses, and know how to properly market their products. The author uses the therm ‘disease monger’, which she explains this is having “a great interest in promoting the notion that the greater population is either already sick or at risk of becoming so.” (p.291). This caused much abuse for diagnosis because it is now a tool to further political, social and commercial interest. The agents who benefit from the increase of diagnostic labels are:

Medical researchers

Medical writers

Health promoters

Health educators

Pharma and diagnostic companies

Doctors

Lawyers

Hospitals

Courts

Insurance companies

They ALL make money from the positive and negative outcomes of drug use. They are creating a perceived need for their products and services and scarcity without them. Mongering is the business of trying to convince well people they are sick and slightly sick people that they are extremely ill.

The author also mentions ‘e-scaped’ medicine which is basically the patient becoming a consumer. Because of direct consumer advertising, online self screenings, patient advocacy organizations and disease awareness campaigns now more than ever people are self diagnosing and paying for treatments they way they want without a professionals advice. Many online informational sites are propped up by the industry so they may gain more consumers and expand the drugs to more than just the target audience.

Jutel, A. (2009). Sociology of diagnosis: a preliminary review. Sociology of Health & Illness. Vol. 3, p.278-299. DOI: 10.1111/j.1467.9566.2008.01152.x

#sociology #diagnoses #drugs #monger #medicine

Drug companies mislead doctors

In Ben Goldacre’s book Bad Pharma: how drug companies mislead doctors and harm patients, he discusses how secrecy, dishonestly, bribery and corruption are in heavy rotation in the Pharma industry. In this brief peer review I found written by Humphrey Rang he summarizes the book and notes key examples that help each element of interest. The main issue in the book is the nondisclosure of data from clinical trials. The example is the antidepressant reboxetine who published one trial to be successful while the other six remained unpublished because they didn’t produce the outcome that was desirable. As a result patients suffered major side effects due to its inefficiency.

here is an additional resource that lists all the side effects of Reboxtine

http://sideeffects.embl.de/drugs/65856/pt

The second main idea of the book is aimed to criticize marketing culture of the Pharma companies, its intrusion into medical education and its influence on prescribing patterns. What is scary about this is that scientists, doctors and regulators support this. From the reading “companies spend about twice as much on marketing as they do on research and development of new drugs” (p.). Much of this is done under the name of ‘research’ but in fact it’s done for marketing purposes. An example complimenting this is the CAST (cardiac arrhythmia suppression trial) antiarrythmic drug trial. Drugs likes encainide and flecainide, which are support to treat irregular heartbeats, actually increased deaths following a heart attack. Over 100,000 people unnecessarily died from this.

Rang, H. (2013). Bad Pharma: how drug companies mislead doctors and harm patients. British Journal of Clinical Pharmacology. 75(5): 1377-1379.

#badpharma #dishonesty #corruption #clinicaltrials #marketing

Physicians under the influence

Pharma firms use financial and non financial tactics to influence health care provider’s attitudes and decision making.

Financial Inducements include

honoraria

gifts

speakers’ fees

unrestricted education grants

sponsored research

and other funder resources

Non financial inducements include

use of deference

the opportunity to be referred as an expert

publication productivity facilitated by industry funded ghostwriters that further the health care professionals career

“Physicians often do not recognize their vulnerability to commercial information and subtle selling techniques” (p.667)

People even doctors are more strongly influenced by messages delivered with confidence and especially if there is money involved, extracting objective information in messages becomes difficult. Most physicians think they are immune to marketing strategies and often believe their own prescribing behavior is unaffected by industry influence, while at the same time they place blame on other physicians for being susceptible to industry influence. So there is an issue with self serving biases within the culture of physicians. There is also a sense of entitlement. Physicians who receive industry funded benefits (like the ones written above) usually use those as a way to unconsciously rationalize questionable behavior regarding ethics in their practice.

Principles of Influence

Reciprocity

Obligations to help those who have helped you

Relationship between physicians and industry uses formalized gift giving rituals

physicians pay back the industry gifts through changes in their practice, however this is seen as showing loyalty in the business relationship NOT a bribe

Commitment and consistency

Pharma industry knows the power help in small commitments

Example: drug rep asks a doctor “will you try my drug on next 5 patients with diabetes?” and because this is a small request it increases the likelihood that the physician will start using the targeted drug

Drugs reps tract physicians’ prescriptions and those who haven’t honored their commitments are reminded and encouraged again and again to try the drug - so there is a lot pressure on doctors as well

Social Proof

Accepting industry gifts is a cultural norm in medicine, so it will continue to happen

Opinions of colleagues are used by industry reps to sway physicians to adopt particular way of thinking

They create social validation and conformity

Liking

Rapport increases with familiartiy

The more interactions and the longer you have a relationship matters in medicine

Drug reps spend a considerable amount of time and effort befriending physicians - they try to make everything seem like a gesture of friendship instead of a business deal

They do this by providing free samples of products, office lunches or dinners etc.

It is similar to buying love in a sense because doctors will write prescriptions for who they like because remember, doctors are people too

Physicians feel overworked, underpaid and unappreciated

Drug reps show sympathy, flattery, food, gifts, services, and income enhancing opportunities and pretend that they want nothing in return. However, this usually is beneficial for their drugs.

Drug reps will usually not continue a relationship with a physician who isn’t prescribing a targeted drug or helping in a way to boost its market share

Authority and Scarcity

Physicians want to have a “key opinion leader” status

This leads to research funding, consulting fees, and more publication productivity that the industry funds

They also feel the personal achievement of being special and important in the medical world

The concept of receiving a “key opinion leader” status obviously gives physicians the feeling they are authoritative figures and it also makes them fight for the stars because of scarcity. This is because the opportunity seems limited so it must mean its more valuable.

Through these methods the industry gives off this illusion that they are generous to physicians when really there have underlining motives.

Sah, S., & Fugh-Berman, A. (2013). Physicians under the Influence: Social Psychology and Industry Marketing Strategies. The Journal of Law, Medicine & Ethics, 41(3), 665-672.

#physicians #drugrep #manipulation #influence

Humira: It can treat arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis

Revlimid: It can treat myelodysplastic syndrome (MDS) (disrupts production of red blood cells), multiple myeloma, and mantle cell lymphoma (MCL) (too much white blood cells).

Ebrel: treats autoimmune diseases

Most of the other drugs on this list are meant to treat different types of cancer, autoimmune diseases, and heart conditions.

Opioid Dependency

Opioid dependency is a specific consequence to the Pharma industry over producing, over prescribing and over marketing prescription drugs. In the United States there is rising crisis surrounding drug addition that is now transcending from the under class to the middle and upper class. Researchers are moving beyond analyzing the illicit drug overdoses and deaths and can now see that middle and upper class communities are being negatively affected by drugs as well. However their drug additions don’t involve illegal substances such as cocaine, heroin or meth. Instead the drugs are legally prescribed to them, with opioid painkillers being one of the top prescriptions on the market with high rates of addition and death.

An opioid is a class of drug that is used to reduce pain that includes heroin and is prescribed as a pain reliever most recognizable as:

oxycodone

hydrocodone

codeine

methadone

morphine

The original intent of these drugs was to treat people with “advanced cancer, severe injuries or after major surgery” (p.318). However now the reasoning is “palliative care or acute pain” (p.318). Most prescriptions are written for patients with chronic non-cancer linked pain such as headaches, fibromyalgia, and back pain.

The reason this problem is out of control is because doctors aren’t taught in med school how addictive these medications are, they are just encouraged to treat pain. So when a patient says they are suffering, they just know they have to make that suffering go away. From a sociological standpoint this is problem primarily in high income countries because doctors don’t have the knowledge to consider alternative treatments. So to see change we would have to incite a major cultural shift.

“The solution lies in reforming the health care system to incentive doctors to talk patients, educate patients, and spend more time with them, not just to prescribe pills and perform surgeries” - Anna Lembke, Assistant Professor of Psychiatry and an addiction specialist at Stanford (p.319)

Anderson, T. (2017) “Curbing Prescription Opioid Dependency: An Epidemic of Overdoses and Deaths from Opioids Is Fuelled by Increased Prescribing and Sales in North America.” Bulletin of the World Health Organization.95.5: 318-319. Web.

#opioids #overdose #dependency #addiction #sociology #consequence

Big Pharma’s focus on blockbuster cancer drugs squeezes out research into potential treatments that are more affordable. Says one researcher: "What is scientific and sexy is driven by what can be monetized."

Pacific Standard is a online magazine that “grapples with the nations’s biggest issues by illuminating what shapes human behavior”

I found this article when analyzing the cost of the top 10 drugs in the market in 2018

I wanted to know how the pharma industry relates to cancer considering most of the drugs on the list are meant to treat cancer.

The article talks about how there are researchers who are trying to find low cost cancer treatments but can’t get the funding to start these projects because the pharma industry doesn’t see it as a investment. Quoted from the article “Pharmaceutical companies exist to make a profit and cannot be expected to cover many important areas of research that go unexplored”.

Michael Retsky who is a cancer survivor and cancer researcher has found through his data (and similar data) inexpensive, low impact chemo treatments (such as asprin) over longer periods of times has a better chance of killing cancer completely and has a higher chance to stop recurrence. However big pharma is putting their money into cancer drugs that cost billions to develop and that can be sold for thousands of dollars a does. Yet cancer is still the #1 cause of death for Americans. Even though the low coast alternatives have shown promise they don’t have enough profit potential in the eyes of the pharma industry to invest in researching them. This is consequence of the corruption within the industry, the priorities set aside helping people over money.

Bernstein, J. (2014). The War on Cancer: Big Pharma is Keeping us From Developing Low-Cost Treatments. Pacific Standard. Retrieved from: https://psmag.com/social-justice/war-cancer-big-pharma-keeping-us-developing-low-cost-treatments-80405

Institutional Corruption of Pharmaceuticals

Corruption is defined as an “impairment of integrity or moral principle”. Institutional corruption is an institution’s deviation from the baseline of integrity. Politically we have congress and we expect them to have integrity and represent our best interests. However, integrity is corrupted here because elections are not publicly funded, so the funds come from companies. From this corruption there is “economy of influence” which causes secrecy, and distortions in the democratic process The situation happens within the medical community between physicians and industry.

In health care there is evidence of a hidden business model to maximize profit for drugs and the original commitment to better health is compromised. Pharmaceutical companies emphasize how much society needs their development of products to improve health. However, companies are usually making drugs that are almost identical to the existing products but have more adverse reactions. This is due to unregulated competition. “These distortion serve commercial interests well and public health poorly” (p.591).

More drugs less benefits

Pharma companies, lobbyists and trade associations all have congress authorizing billions in taxpayer contributions to exempted them from market competition and give them special privileges. The money is devoted to developing drugs that are molecularity different but therapeutically the same, and this usually has less risk and cost for manufacturers. Then the drugs are sold through competition on the basis on brand name, patent status and newness to the market instead of therapeutic merits. Regardless of the of small number of clinically superior drugs the sales have increased due to marketing and physicians prescribing the much most costly products.

Harmful side effects

Most new drugs approved and promoted since the 70′s don’t have any better advantages over existing drugs and are accompanied by more harmful side effects. This is because there is distortion, limitations and circumventing during safety regulations. First, its because the FDA tests drugs against placebos rather than against established effective treatments. So there is no real progress, instead just repetition. Second, companies are allowed to test their own products and design trials in way s to maximize their benefits for putting drugs on the market. Third, companies created the “trial journal pipeline”, which basically makes trials and journal articles as marketing vehicles because they usually don’t negative results.

Restoring institutional integrity for safer drugs

Research companies should have ZERO role in testing drugs

right now its too biases and conflicted

The FDA needs new leadership so they gain back public trust and create a new culture surrounded by safety through new rules and enforcement on existing rules

User fees need to stop

The FDA should be funded entirely by taxpayers as consumers because then they will care about who they serve

There needs to be patient relevant evidence of superiority of therapeutically equivalent drugs

There needs to be more follow up after drugs hit the market

Congress also needs to restore trust by creating a drug and safety board with acceptable power, funds and mandates to independently investigate and report on the safety of drugs

Light, D., Lexchin, J., & Darrow, J. (2013). Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs. Journal of Law, Medicine & Ethics,41(3), 590-600.

#solutions #restoring #saferdrugs #institutional

Conclusion

We can see now how Pharma has a strong grip on many different powerful systems in the United States. They have managed to influence the political structure by telling us what is “safe” and “effective” in the drugs we take. Because they create their own science and are protected by the law, which has changed our entire attitudes and understanding of drugs. Now we can’t even place blame on our doctors because they are only a product of the social make up surround by the health care industry.

The power of marketing is really what drives Pharma in a negative direction. The money flowing in creates their power and with that power they are able to influence all these different avenues of care. Because of this influence there are consequences such as manipulation over doctors, holds on real research, overdosing the public and so on and so forth.

The chances of restoring this industry so they can provide more transparency is little to none at this point in time. All we can realistically do is try and give out as much information about “bad pharma” so that the culture can slowly start to shift away from a medicalized foundation. With the increasing use of technology maybe there is hope.

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