What Ever Happened to 'An Apple a Day'?

Making the case that Big Pharma is obsessed with saleseven at the risk of patients' health

Editor's Rating:

The Good: A compelling indictment of Big Pharma's aggressive marketing.

The Bad: Executives and doctors should have been allowed to tell their side of the incidents the author describes.

The Bottom Line: Eye-opening and disturbing.

Our Daily Meds:How the Pharmaceutical CompaniesTransformed Themselves intoSlick Marketing Machines andHooked the Nation on Prescription Drugs

By Melody PetersenFarrar, Straus & Giroux; 432 pp.; $26

Once upon a time, there was a drug executive who actually thought helping patients was more important than the bottom line. "We try never to forget that medicine is for the people. It is not for the profits," said George W. Merck, president of the company that bears his father's name, in 1950. Merck (MRK) even gave away his company's patents for streptomycin in 1946 to make the lifesaving antibiotic more affordable.

Such public-spiritedness now seems like a fairy tale, as former New York Times reporter Melody Petersen documents in her compelling, if sometimes one-sided, new book, Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. While there still are plenty of industry executives and scientists who want what's best for patients, drug companies have largely flipped Merck's dictum, as Petersen shows using industry memos, transcripts of meetings, and other sources. Petersen writes that drug companies push medicines they know don't work. They invent "diseases," such as overactive bladder or compulsive shopping disorder, to wring high profits out of marginal medicines. They obfuscate the science by controlling the publication of clinical trial results and writing bogus journal articles. And they shovel millions of dollars to doctors to boost prescriptions. "Selling prescription drugs—rather than discovering them—has become the pharmaceutical industry's obsession," Petersen writes.

If the products being sold were perfumes or cars, the book would be an amusing romp through the clever tactics of savvy marketers. But drugs are different. They can cause harm. Not only are "vast sums of the nation's health-care dollars...wasted on unnecessary medicines," Petersen writes, but the nation also "may now pay as much to care for patients who were harmed by their prescriptions as it spends on those medicines in the first place." A 1998 University of Toronto study estimated that 106,000 Americans died in one year from "medicines that had been properly prescribed and taken exactly as directed."

How did this happen? Petersen sees a turning point in the early 1980s, after Smith Kline had introduced an acid-fighting drug, Tagamet, that helped heal ulcers. Rival Glaxo came up with a copycat, Zantac, in 1983. But rather than being satisfied with a small slice of the ulcer market, Petersen writes, Glaxo CEO Paul Girolami launched "one of the most expensive and aggressive promotional campaigns the industry had even seen, one that even today is talked about by the nation's drug marketers." Girolami set Zantac's price 50% higher than Tagamet's and pitched it for gastroesophageal reflux disease, a.k.a. heartburn. Glaxo "set out to make heartburn into an acute and chronic 'disorder' that came with serious consequences if not treated twice daily with the company's two-dollar pill." It worked. Zantac became the best-selling drug in the world, and the industry "learned that Americans would pay almost anything for a new pharmaceutical product, even if it wasn't really new," the author says.

From there, drugmakers turned to even more aggressive tactics. The worst known case: a marginal epilepsy drug called Neurotin that Parke-Davis (and, later, Warner-Lambert) pushed for pain and other unapproved uses, turning it into a blockbuster. "The crux of the illegal plan came down to finding doctors willing to be paid to tell other physicians that Neurotin was a miracle drug," Petersen explains.

Enticed with fancy dinners, lavish retreats, and cash, doctors rushed to sign on and prescribe the drug. "I underwent a stunning revision of my beliefs about the medical profession," recounted whistleblower David Franklin, a sales rep. "You'd like to think this kind of simple scheme wouldn't work with physicians.

It works remarkably well." As a result of a case brought by Franklin, Warner-Lambert, which had been acquired by Pfizer (PFE), was found guilty of criminal charges in 2004 and paid a $430 million fine. But "perhaps the only thing that made the...case unique was that the companies had failed...to keep the documents and the fact of the fraud a secret," says Petersen.

The book is full of such eye-opening stories. Eli Lilly (LLY) repacked Prozac in a lavender-and-pink capsule and pushed the drug for what it calls "premenstrual dysphoric disorder." Novartis (NVS), concerned about declining Ritalin sales, apparently claimed that girls are vastly undertreated for attention deficit disorder because their symptoms go unrecognized. The main symptom, according to Novartis? Sitting quietly. Then there are the sad tales of people such as Peter Koppen, who spent his preteen years in a haze of pharmaceuticals prescribed by psychiatrists when what he really needed was a helping hand after his father's death when he was 7. "I was out of it all the time," Peter remembered. "I just needed someone to spend more time with me."

The book could have been more revealing had the executives and doctors whose speeches and memos Petersen quotes been given a chance to respond. But her conclusion is pretty convincing even so. "The industry has been transformed from one with the ability to do great good to one that is causing far too much needless harm."

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