license to ill

License to Ill

Increasingly, drug companies aren't just selling cures. They're also
marketing disease.

By Bradford Plumer

July 25, 2005


-----snip-----

>>From a pharmaceutical company's perspective, the big money can be made
not only by selling drugs to the sick, but by selling drugs to the
healthy, the people who don't even know that they need drugs yet. A
recent Reuters Business Insight report, designed for drug company
executives, suggested that the drug companies can reap billions by
"creat[ing] new disease markets." That involves convincing people that
"problems they may previously have accepted as, perhaps, an
inconvenience"-such as, for instance, the distress that can accompany
PMS-are in fact "worthy of medical intervention." In other words,
nothing short of the medicalization of everyday troubles. Cheerfully,
the report believes that drug companies are up to the task: "The coming
years will bear greater witness to the corporate sponsored creation of
disease."

If it sounds ominous, it is. As Ray Moynihan and Alan Cassels document
in their new book, Selling Sickness, the "corporate sponsored creation
of disease" is rapidly gaining ground, often with appalling results. To
be sure, many diseases are obviously very real and the latest
treatments can often do a world of good. But some health problems are
so mild or temporary-high-blood pressure, for instance, or
menopause-that powerful treatments can often do more harm than simply
leaving it alone. Yet that hasn't stopped drug industry from tapping
its multi-billion dollar marketing budget to "raise awareness" for new
illnesses or ginning up scare stories over light medical conditions.
The gap between "marketing messages and scientific truths... is often
as wide as it is frightening," say the authors, and this book is an
attempt to bridge that gap.


Here are some strategies for marketing illnesses. The first thing to do
is to hire a PR firm to "brand" a certain condition. When GSK, an
American drug company, wanted to repackage its best-selling
anti-depressent, Paxil, to treat "social anxiety disorder"-a
questionable variation of "social phobia" that requires medication
rather than therapy-it hired PR firm Cohn & Wolfe to help raise
awareness about the condition. Slogans were developed: "Imagine being
allergic to people." Posters depicting sad men and women brought to
light the symptoms, which only seem like normal nervousness to the
untrained eye: "You blush, you sweat, shake-even find it hard to
breath. That's what social anxiety disorder feels like." Journalists
were faxed press releases so that they could write up
attention-grabbing stories about the new disorder in the New York Times
and Wall Street Journal. (Does the deadline-pressed journalist need a
bit of color for her story? No problem! Patient-advocacy groups,
usually funded by drug companies, can provide patients to interview.)
GSK even got University of California psychiatrist Murray Stein to
vouch for the drug. Stein, it turns out, was a paid consultant to
seventeen drug companies, including GSK, and had run company-funded
trials of Paxil to treat social anxiety disorder.

Celebrities, too, can help bring new diseases to the public eye-as
football star Ricky Williams did in 2002 after revealing that he had
social anxiety disorder. His appearances on Oprah and other talk shows
generated a wave of publicity for GSK, and Paxil, although few of the
shows disclosed that Williams was being paid by the company to raise
awareness for the disease, and rarely was it mentioned that doctors had
long known about severe withdrawal effects associated with Paxil.

Oftentimes celebrities can be paid to say things that drug companies
could never get away with: In 2002, supermodel Lauren Hutton appeared
in a Parade magazine cover story-a newspaper insert seen by over 70
Americans-telling her audience that her "No. 1 secret" for dealing
with menopause was hormone therapy. Perhaps lost on most readers was
the fact that Hutton had signed a contract with Wyeth, a drug company
offering hormone therapy for menopause, and that under FDA regulations
the company itself could never have made such one-sided claims. (Many
doctors dispute that menopause should even be considered a medical
condition, and the most comprehensive trials on hormone therapy, run in
1998, found that drugs did no better than placebos at treating symptoms
of menopause, and might even increase a woman's chance of having a
heart attack. Wyeth, resilient as ever, responded to the trial results
with a new marketing campaign to remind women and doctors of the
dangers of estrogen loss at menopause.)

Everywhere one looks, drug money is sloshing about. During the 1990s,
the U.S. National Institute of Health's cholesterol guidelines
estimated that 13 million Americans could benefit from treatment with
statins-new cholesterol-lowering drugs. In 2001, a new panel of
experts revised that number upwards, to 36 million. In 2004, another
panel updated the guidelines again, to 40 million, a number that
included many Americans with relatively low risk of a future heart
attack. Why was this? Was it actually true that statins could now
benefit not only the sick, but the healthy as well? It's possible. But
it's hard to ignore the fact that eight of the nine experts who wrote
the 2004 guidelines also serve as paid speakers, consultants, or
researchers to drug companies-companies that stood to reap billions
from overnight changes that relabeled healthy people as sick and
created a new market for statins.

This doesn't mean the experts deliberately fudged the results, although
many researchers who aren't on the take, such as Dr. John Abramson of
Harvard, believe that statins, while useful for those who have suffered
heart attacks, offer very little benefit to healthy individuals, and
may even cause harmful side-effects. Rather, the problem is that it's
impossible to trust industry-funded numbers. A 2002 study estimated
that almost 90 percent of those who write guidelines for their peers
have financial conflicts of interests with drug companies. Combine that
with the knowledge that, as Moynihan and Cassels write: "The industry's
sponsorship is strategic, systematic, and systemic." That sponsorship
is designed to portray conditions that often are not very well
understood as severe, widespread, and, above all, treatable with drug
therapy. That's not to say that doctors are being paid to go against
their better judgment and shill for drug companies. But it does put the
objectivity of medical science into severe doubt.

Where is the Food and Drug Administration in all of this? Disturbingly,
on the take. Over 50 percent of the agency's budget for reviewing drugs
comes from the pharmaceutical industry, and not surprisingly, officials
are loath to offend their paymasters. In 2000, FDA researchers
recommended that the agency consider pulling a controversial medication
from the market. Lotronex, a new drug manufactured by GSK, had been
used to treat irritable bowel syndrome, a condition that can be
extremely debilitating for some, but relatively minor for others. The
condition, of course, had been played up by a GSK marketing campaign
suggesting that some 45 million Americans were affected by the
condition, although that was very far from the scientific consensus.
The trouble was that FDA researchers had discovered two horrific side
effects of Lotronex: Some users would experience constipation so severe
that impacted feces could perforate the inner bowel wall and lead to
fatal infections; other users were contracting isachaemic cholitis, a
potentially fatal condition in which the blood can stop flowing to the
bowels. Many drugs, of course, can have severe side effects; what was
shocking here is that many patients were, potentially, being
unnecessarily exposed to such gruesome risks.

--------snip------

What really needs to happen is that public gatekeepers-especially
journalists and doctors-need to be more aware of what is going on.
Moynihan and Cassels give some signs that this is happening: Carla
Johnson, a medical reporter for the Spokane Spokesman-Review recently
wrote an attention-grabbing expose on the medicalization of female
sexual dysfunction after she grew suspicious of a faxed press release
claiming that 43 percent of women suffer from the condition. Meanwhile,
the American Medical Student Association, "literally the face of
tomorrow's physician," has been engaging a "PharmFree" campaign to
convince its members not to accept handouts from drug companies trying
to ingratiate themselves to the next generation of doctors. But in
addition to all that, a wider cultural change may need to take
place-perhaps a new understanding that not every condition of daily
life reduces down to neurobiology, and that there's not necessarily a
pill for every problem.


fairuse

http://www.motherjones.com/commentary/columns/2005/07/selling_sickness.html

.