We’re all drug addicts…

Many students have written about profit-making “Big Pharma” in their answers to the question: Is science today as much about profit as improving the world? More specifically, “Big pharma” does not literally mean big pharmaceutical companies, but rather it refers to:

The pharmaceutical lobby — also known as the drug lobby or Big Pharma — refers to the paid representatives of large pharmaceuticaland biomedicine companies in the United States who seek to influence federal government policy. (From Wikipedia)

So, it actually refers not just to big pharmaceutical companies, but also their sociopolitical clout in a country. Why it this important? Well, health is always an issue–but these big drug companies also influence the government to enact policies that will ensure a market friendly to the continual consumption of such drugs. Controversy has also arisen over Big Pharma’s association with doctors and medical journals–shedding doubt over the objectivity of these medical bodies.

Some notable readings or examples worth mentioning in any discussion about profit and big pharmaceutical companies include the following:

The article “Pharmaceutical Branding: Identity, Individuality, and Illness” talks about how illness is socially constructed by drug companies:

Fluoxetine under the brand of Prozac is white and green, and was introduced as an antidepressant; under the brand Sarafem, it is pink and lavender, and is offered to women as a treatment for PMDD. Pharmaceutical products are taking on symbolic lives—“Sarafem ” is homophonic with “seraphim,” from the Hebrew word meaning “angel,” and targeted to fem ales—and represent a constellation of cultural messages regarding illness .

And of course this construction has an economic motive, which is basically to artificially extend the life of certain drugs whose patents are expiring:

Marketing journals at the time spoke of Sarafem as part of an attempt by Lilly (the manufacturer) to minimize losses from Prozac’s patent expiration, and IMS-Health (a large market intelligence firm for pharmaceutical and healthcare industries) also anticipated the appearance of Sarafem as a tactic to “combat generic erosion”

A similar case concerns Nexium and Prolisec.

What’s the difference? Well, Nexium is the left-handed version of omeprazole. In chemistry, S stands for sinister, which means the molecular conformation has a left-handed orientation. (D would be right handed.) So this S-omeprazole is one half of the mixture that comprises it’s predecessor. By specifically picking only the S conformation, the drug is made more potent. This sounds great, but its efficacy is only marginally better than Prilosec — which has a generic version, and costs about a third less than Nexium. Is this slight increase in efficacy worth 1/3 more? Well, AstraZeneca’s own research suggests that they are not. Nexium was created because AZ’s patent on Prilosec was finally running out, and they wanted to continue to making money from one of their flagship drugs so they released a new version that costs more and performed only partially better. This is the classic definition of a “me-too” drug. Often the research is sort of doctored to make the new drug seem much better than the old. In the case of Nexium, the literature put out by AstraZeneca compared 20mg of Prilosec to 40mg of Nexium. Of course Nexium performed better.

A company of note is Pfizer, arguably ranking number one in global drug sales. The company has long list of legislation and litigation casesthat you can mention should you need further examples, such as their Bextra settlement of off-label marketing investigation and their problematic antibiotic experiment in Nigera.

Lastly, there is the  restless leg syndrome. This article in particular discusses how media helps to make people sick.

“Disease mongering” is the effort by pharmaceutical companies (or others with similar financial interests) to enlarge the market for a treatment by convincing people that they are sick and need medical intervention. Typically, the disease is vague, with nonspecific symptoms spanning a broad spectrum of severity—from everyday experiences many people would not even call “symptoms,” to profound suffering. The market for treatment gets enlarged in two ways: by narrowing the definition of health so normal experiences get labeled as pathologic, and by expanding the definition of disease to include earlier, milder, and presymptomatic forms (e.g., regarding a risk factor such as high cholesterol as a disease in itself).

An excerpt of the writers’ analysis:

The news coverage of restless legs syndrome is disturbing. It exaggerated the prevalence of disease and the need for treatment, and failed to consider the problems of overdiagnosis. In essence, the media seemed to have been co-opted into the disease-mongering process. Although our review was limited to the coverage of a single disease promotion campaign, we think it is likely that our findings would apply to others. It is easy to understand why the media would be attracted to disease promotion stories and why they would be covered uncritically. The stories are full of drama: a huge but unrecognized public health crisis, compelling personal anecdotes, uncaring or ignorant doctors, and miracle cures.

Looking at the various cases mentioned, what’s your perception of the pharmaceutical industry now? Are their actions ethical and necessary? 

How would you propose governments regulate such industries for the benefit of the consumers?


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