Medicating For Profit
Currently, the U.S. “uses over…forty percent of all the drugs produced in the world each year, according to the World Health Organization” (Murray, 2009, p.9). Since 2009, that percentage has gone up, which isn’t surprising if you consider that we are one of only two developed countries who allow direct to consumer marketing of pharmaceutical drugs, the other being New Zealand. From blood pressure medication to antidepressants, the average American stands a good chance of watching commercials for prescription drugs on a daily basis. There is no doubt that we live in a culture that endorses the idea of supposed “need.” You “need” to be, have and produce many things, according to our many explicit and implied cultural messages. From toothpaste to tanning, we are constantly being told that we need something. Naturally, when it comes to matters of health, people are all too eager to get what they need. But what if that’s an issue of dispute? The industrial nature of such a marketing and business alliance—all in the name of medicine—of today’s lobbyists, politicians, psychiatrists and pharmaceutical companies presents a major health concern for the average United States citizen.
The History of Pharmaceuticals
In some ways, the use of drugs for medicinal purposes has been even less regulated than it is now. Pharmaceutical drugs used to be sold just like anything else on store shelves (Mosher, 2007). These drugs included some that are now illegal, such as cocaine and heroin (Cohen&Inaba, 2011). In 1970, not only were many of these items off the shelf, but the United States passed the Controlled Substances Act, mostly in response to the prevalent drug use of the 1960s. According to the Seventh Edition of “Uppers, Downers, All Arounders,” the main obligations of the Drug Enforcement Administration were: “to classify all psychoactive drugs, to control their manufacture and sale, to limit imports and exports, [and] to define criminal penalties” (Cohen &Inaba, 2011, 1.38). To this day, the classifications of psychoactive substances are widely disputed. An extremely relevant example of this can be found in our recent decision to legalize Marijuana use in Washington and Colorado. Technically, marijuana is classified as a Schedule 1 drug, associated with a high potential for abuse and defined as having no medical value, and yet people have been using it for medicinal purposes to cope with pain for years in several states. It is perhaps due to such an irrational coexistence of contradicting facts that a leading college textbook can confidently state: “The U.S. government’s views of drug and alcohol use and abuse have varied widely over the centuries, but most policy decisions made in the past 50 years were due to the prevailing political climate rather than scientific and sociological research. The budget for the U.S> “War on Drugs” has gone from $3.7 million in 1971 to $15.1 billion in 2011” (Cohen &Inaba, 2011, 1.39).
Now, although we’ve made “hard” drugs theoretically more difficult to access, pharmaceutical companies have found ways around safety and labeling regulations, as well as increasing sales at an alarming rate due to excessive advertising. Let’s begin with dissecting their marketing strategy.
Before 1997, advertising these drugs was illegal (Murray, 2009, p.213). Since 1997,we have been advertising prescription drugs with very little to no FDA regulation in place to put a barrier between consumers and drug companies. Like any other marketing ploy, the strategy continues to be employed only if it appears to be working—and it does. Two years after the U.S. began advertising pharmaceutical drugs, Americans were being exposed to nine ads for prescription drugs per day, on average (Mosher, 2007). By 2009, drug companies were spending “more than $57.5 billion per year marketing to physicians” (Murray, 2009), much less consumers.
Not surprisingly, the public’s acceptance of pharmaceutical drugs had more to do with well-trained salesmen than medical science, beginning with “detail men” who were trained with sale literature and in-house company newsletters after World War II (Greene, 2004). More recently, two Canadian researchers found that drug companies now spend at least twice the money on marketing as they do on the research and development of their drugs (Gagnon &Lexchin, as cited in Murray, 2009). Unfortunately, the common practice of DTC (direct to consumer) marketing is one of the biggest culprits for what we now refer to as “Big Pharma,” a five hundred billion dollar industry (Moynihan &Cassels, 2005)that has leaked into the facets of medical education and general medical practice.
Pharmaceuticals Going Mainstream
Merck, a leading international pharmaceutical company, provides a perfect illustration of how all these principles come into play, how they affect consumers, and what actions (if any) are taken against drug companies. Henry Gadsden, the head of Merck over three decades ago, was once quoted as saying he wanted Merck’s brand to be sold to everyone, even the healthy (Murray, 2009, p.15) Essentially, we must ask ourselves whether there is there a need or they are manufacturing one. Peter Whitehouse, a former consultant for pharmaceutical and biotechnological industries, asserted that large pharmaceutical companies were indeed doing just that. In“Why I No Longer Consult for Drug Companies,” he writes of giving up his career because [the pharmaceutical companies] were “[creating] diseases for drugs” (Whitehouse, 2008). Kristin Barker of Social Science & Medicine holds a similar opinion.
Barker argues that there is a “cultural logic whereby the existence (and marketing) of an officially approved prescription medication for a condition lends support to the biomedical existence of the condition itself,” which she calls “pharmaceutical determinism.” She cites the example of fibromyalgia, an illness that physicians cannot even agree exists. Not only do patients diagnosed with this disease face skepticism with their symptoms, but they may be taking a drug that was formulated with no purpose other than to relieve symptoms and make profits, rather than actually treat a viable, authentic syndrome. The drug Barker references is Lyrica, an FDA approved prescription medication.
According to her article,“Listening to Lyrica: Contested Illnesses and Pharmaceutical Determinism,” Barker sees evidence that “pharmaceutical companies…[play a large role]in promoting and legitimating contested diagnoses and validating those who are so diagnosed.” (Barker, 2011) In other words, a patient’s diagnosis could have more to do with the greed of pharmaceutical companies than a scientific analysis of their symptoms. This opinion is echoed by Dr. Marcia Angell, who acknowledges that though drug companies used to make drugs for treatment purposes, the culture has changed drastically. “Now it is often just the opposite. They promote diseases to fit their drugs” (as quoted in Murray, 2009, p.101).
By all accounts, it appears as though there is not so much a rising surge in ailments and mental cases since the early 1900s but a greater number of drugs needing to be sold. To illustrate how this principle works, take into consideration that the ratio of surgeons in an area actually increases the number of surgeries performed (Murray, 2009). Dr. Michael Murray writes, “One research study found that an area with 4.5 surgeons per 10,000 …experienced 940 operations…whereas an area with 2.5 surgeons per 10,000 experienced 590 operations per 10,000. Basically, when the concentration of surgeons doubles, so does the rate of surgeries” (Murray, 2009, p.14).
This profit-seeking or “pharmaceutical determinism” extends to the decisions made by pharmaceutical companies in regards to patents. In an article released by the Economic Development Quarterly in 2004, they reported a connection between patent activity within the U.S. pharmaceutical industry and economic conditions of a geographic location, finding that “local business conditions play an important role in the innovation and financial performance of U.S. pharmaceutical companies” (MacPherson &Boasson, 2004). If pharmaceutical companies were truly rooted in fulfilling the needs of a specific population, it stands to reason that economic factors would not have such a notable impact.
For those wondering where the FDA is in all of this, the simple answer is that they are right there alongside the pharmaceutical reps, working hand in hand. Studies that determine the safety and efficacy of prescription drugs are organized and funded by the major pharmaceutical companies (Mosher, 2007). In 2007, it was estimated that ninety-percent of the clinical research was “sponsored by drug companies” (Murray, 2009, p.18). For example, the majority of researchers on the panel for Paxil development and evaluation were psychiatrists, all of whom had financial ties to major pharmaceutical companies (Burwell &Stith, 2008, documentary). A study published in 2010 found significant financial gifts (up to 69% of overall funding) in the state of Vermont between pharmaceutical companies and specialists in psychiatry (Chimonas, et al. 2010). Although all these are covered by “disclosure laws,” which maintain that it is acceptable to have a conflict of interest in this scenario as long as it’s openly stated, it can and should make the average citizen question the validity of research being done in the field of psychiatry.
Furthermore, while it’s no secret that document review procedures are often inefficient within drug companies (Bernhardt, 2003), the public has it all wrong if they suppose that the studies done on their antidepressants are strictly scientific. When JAMA (Journal of the American Medical Association) evaluated the research quality, they found an overwhelming bulk of medical studies “[contained] false or misleading statistics” (Murray, 2009, p.17).
The Birth, Usage and Expansion of the DSM
It has been argued that the prevalence of psychiatric drugs in particular arose out of the increasing pressure on psychiatrists to produce evidence-based practices for actual diagnosis, in order to be seen as providing “cures” in the same way as most medical practitioners. (Burwell &Stith, 2008, documentary) They needed official guidelines for mental illnesses, and they needed viable treatments. Enter the DSM (Diagnostic Statistical Manual). The first edition consisted of just over 100 mental disorders, quite a step up from the vague general label of lunatic. Now, as we await the release of the DSM-V, we currently have over 300 mental illnesses listed in the fourth edition. (Burwell &Stith, 2008, documentary) With such numerous options for mental maladies, who couldn’t find a disorder for which they might need a pill?
That is why DTC Advertising has become such a hot topic. With television ads telling us to consider “talking to our doctor” about every other human peculiarity, it is no wonder that one out of eight who ask for and receive a medication first learned about it via advertising (Landers, 2001, as cited in Mosher, 2007, p.343). The odds of finding a disorder might also substantially increase with the expansion of what is considered abnormal.
Over-Diagnosis and Its Effects on Vulnerable Populations
Recently, the media has come out with multiple reports regarding the changes we can expect in the fifth and newest edition of the DSM (Diagnostic Statistical Manual). Some of these changes include: Disruptive Mood Disregulation Disorder (temper tantrums), Major Depressive Disorder (bereavement following the loss of a loved one), Binge Eating Disorder (eating too much twelve times in three months), and Adult Attention Deficit Disorder, just to name a few. (Frances, 2012). Of course, the implications of the changes are that you may be slapped with a label and medicated with greater ease.
While senior citizens remain one of the most directly affected by over-diagnosis for physical ailments (Murray, 2009, p.11), these changes in psychiatry guidelines and practices have resulted and will continue to result in yet another fragile population, children, being prescribed drugs for everything from over-activity to emotional outbursts.
In 2011, I saw this firsthand while working in a residential home for foster children who were either newly in the system, or had extreme behavioral issues that prevented a family placement. Out of the twelve children from ages 6-12, all but one were on at least two medications. Given that they were all victims of some form of neglect or abuse, I would have expected therapy rather than a medical diagnosis, or at least an admission that therapy would be the preferred method of dealing with their various methods of acting out. The opinion among staff members was to the contrary. In addition, I was trained in how to count, record and track their medication each day, just to make sure that no counselors were stealing and using supposedly “harmless” medication.
I couldn’t help but wonder why they were worried about staff members wanting access to medication that was apparently safe for young, developing minds. If it was potent enough for adults to be affected, it should not have been given to children after the first visit with a child psychologist present, followed by a recommendation to a psychiatrist. Perhaps the most troubling aspect of this particular example is that the children in foster care represent one of the most vulnerable demographics.
As noted in the earlier reference to anticipated DSM-V changes, finding a disorder has not been—and will not be—difficult. Without blood tests that “prove” someone has Obsessive Compulsive Disorder, psychiatrists are obligated to diagnose according to their manual. This obviously influences how quickly and easily a child can be diagnosed with anything from ADHD to Bipolar Disorder. In a study published earlier this year, it was found that children undergoing tests for Central Auditory Process Disorder had different results depending on the testing method. In this case, the results ranged from 7.3% being diagnosed as positive to 96% with a positive diagnosis. When the tests methods were strict, a mere 7.3% were diagnosed, whereas with lenient testing, they (obviously) arrived at a much higher percentage. Both testing methods were considered scientifically and medically valid (Wilsona&Arnotta, 2013). It is only common sense that if lenient testing can be applied and yield a higher (aka: more profitable) number, then that is the testing method psychiatrists may be more apt to use.
It is almost ironic to call pharmaceuticals “legal” drugs. There must be reasons, after all, why such powerful entities would need to pay for faulty research to support their practices.
In 2002, Japanese patients began reporting negative side effects from Zyprexa. Eli Lilly & Co. was then ordered to place warning labels on the drugs. More recently, lawsuits against them in 2006 have shown little positive change within the company. Fearing that this would impact sales, not only did they try to hide the adverse effects of the drug, but they “pursued a strategy of creating a shadow science to drown out non company-sponsored (and competitors’) research reports [on the adverse effects]” (Applbaum, 2010).
In 2003, GlaxoSmithKline overcharged Medicaid for two commonly used drugs, resulting in an $87.3 million payment. Bayer also overcharged for an antibiotic, and was fined $257 million for violating federal laws (Petersen, 2003, as cited by Mosher, 2007, p.346-347).
Though no lawsuits were filed, Pfizer was directly addressed by the World Health Organization in 2003 for launching a misleading ad, which Pfizer did not correct (Moynihan &Cassels, 2005, p.14). Pfizer did however end up paying the federal government $430 million after off-label marketing drove Neurontin’s sales up to $2.7 billion, all with inaccurate, partial and misleading information (Murray, 2009, p.19).
And that short list is just the tip of the iceberg in pharmaceutical misconduct.
Death of the Hippocratic Oath
From excessive marketing of prescription drugs to criminal practices such as delaying generic drug release, off label usage, misdirection of profit,and product review ghostwriting, pharmaceutical companies are doing more harm than good.
People are dying at alarming rates due to prescription drug abuse, misuse and overdoses. Annually, over 100,000 U.S. citizens died from known side effects while taking prescribed drugs in exactly the way they were instructed. (Perdomo, 2010) This does not count those who abuse prescription drugs, those who steal a friend or family member’s prescription medication, or those who overdose intentionally. However, the prevalence of those who abuse prescription drugs is another troubling statistic. In a 2009 CBS news report, one in five teenagers admitted to abusing prescription drugs (Couric, 2009). Between 1999 and 2008, the number of deaths attributed to legal drugs rose from 4,000 to 15,000, and the CDC has now labeled prescription drug abuse an epidemic (Sabet, 2012).
To put that in perspective, the number of people dying from prescription drug use or abuse more than doubled, and quite nearly tripled during that short time frame. If the United States is so fervently anti-drugs, and if pharmaceutical drugs are medical and scientific, then either the doctors aren’t paying attention, the patients aren’t paying attention, or the medical field has been dominated by Big Pharma.
*Author’s Note: I wrote this for a Sociology class at WSU, but found the issues are still relevant. Furthermore, all of the complaints, regulations and legalities regarding marijuana, tobacco and perhaps even e-cigarette use are hypocritical considering our history of prescribing much more potent substances.
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