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Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescri

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Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescri Cover

 

 

Excerpt

Introduction

Doctors call it the resurrection drug. They have watched as it freed patients from what seemed an inescapable death.

The medicine treats sleeping sickness, a disease far more lethal and terrifying than its name implies. Opportunistic tsetse flies spread the disease through much of Africa, devastating villages and killing tens of thousands of people a year. The jewel-eyed yellowish brown flies thrive in thickets along rivers where women and children go to collect water. With a bite, the bloodsuckers inject deadly parasites into their human victims. As the parasites multiply, their human hosts appear to go mad. The victims grow agitated and confused, slur their speech, and stumble. Finally come coma and death.

The pharmaceutical company that manufactured the medicine, a failed cancer drug with the tongue-twisting name eflornithine, abandoned it in 1995, seeing no profit in selling it in poor countries.

But the resurrection drug made its own revival a few years later—not in Africa, but in the United States, a land free of tsetse flies but with fourteen million women worried about unwanted facial hair. Another company began selling it in the form of a depilatory cream to minimize female mustaches. With its lavender-colored logo resembling a graceful swan and advertisements sporting young, beautiful models, eflornithine became another prescription drug marketing success.

The company christened its product Vaniqa.

 
 
This is a book about a great transformation in the prescription drug industry over the last twenty-five years. Once the most successful pharmaceutical companies were those with the brightest scientists searching for cures. Now the most profitable and powerful drugmakers are those with the most creative and aggressive marketers. The drug companies have become marketing machines, selling antidepressants like Paxil, pain pills like Celebrex, and heart medications like Lipitor with the same methods that Coca-Cola uses to sell Sprite and Procter & Gamble uses to sell Tide.

Selling prescription drugs—rather than discovering them—has become the pharmaceutical industrys obsession.

Prescription drug marketing now permeates every corner of American society—from Sesame Street to nursing homes to the nightly news. Medicine ads sprout from billboards, scoreboards, the hoods of race cars, and the back covers of magazines—all once venues of the similarly ubiquitous cigarette ads of the 1960s and 1970s. Imitating neighborhood grocers, the drugmakers offer coupons, free gifts, and deals to buy six prescriptions and get one free. They hold sweepstakes and scholarship contests. They pay to sponsor rock concerts, movie premieres, and baseballs major leagues.

The marketers make the use of their dangerous medicines look attractive and easy. Fentanyl, an addictive narcotic eighty times more potent than morphine, comes in a berry-flavored lollipop. Syringes used to inject children with growth hormone look like kaleidoscope-colored writing pens and PlaySkool toys. In 2006 drug companies gained approval to coat their pills with “pearlescent pigments” to enhance them with a shimmery satin luster and make them look as precious as their price.

During New Yorks 2003 Fashion Week, swimsuit models shimmied down the catwalk, showing off Johnson & Johnsons new contraceptive, a white-colored patch that was glued to the skin. By wearing the drug as a fashion accessory, one company executive explained, women “can look beautiful and feel confident.”

Men attending professional golf tournaments in 2004 heard a different pitch. Step right up for free tips on your golf game, offered marketers working in a tent promoting Cialis, a drug for erectile dysfunction. Step right up for a free video lesson from a sports psychologist, the salesmen invited. By the way, they added, do we have the perfect drug for you!

America has become the worlds greatest medicine show.

The marketing works. Never have Americans taken so many prescription drugs.

Americans spent $250 billion in 2005 on prescription drugs, more than the combined gross domestic product of Argentina and Peru. Americans spent more on prescription drugs in 2004 than they did on gasoline or fast food. They paid twice as much for their prescription medicines that year as they spent on either higher education or new automobiles.

The American prescription drug market is so lucrative that many foreign drug companies have moved in and now depend on Americans for most of their profits. For foreign executives, the math is simple. Americans spend more on medicines than do all the people of Japan, Germany, France, Italy, Spain, the United Kingdom, Australia, New Zealand, Canada, Mexico, Brazil, and Argentina combined.

As the medicine merchants have poured billions of dollars into selling their wares, they have become Americas most powerful industry. In the process, they have transformed American life. The small white-capped whiskey-colored bottles that once took up a corner of the bathroom cabinet now play a role in lives that few products can match. Almost 65 percent of the nation now takes a drug available only by prescription. Children line up in the dining hall of their summer camps to get their daily doses. Pharmacies stay open twenty-four hours to meet Americas demand. Even the dogs get Prozac if they howl too much at the moon.

The pharmaceutical companies build their laboratories on the campuses of public universities. They recruit patients for clinical trials at shopping malls and county fairs. On network television, the plots of prime-time shows revolve around brand name prescription drugs, at times at the suggestion of marketers at a pharmaceutical company.

The medicine promoters have turned what were once normal life events—menopause, despair from a divorce, anxiety caused by a workaholic boss—into maladies that can be treated with a pill. After all, when patients are customers and medicines are commodities, the industry thrives when people are ill—or believe they are.

The companies have found the United States, with its consumer-driven culture, a perfect medicine market. We expect instant gratification of our desires and a quick fix for whatever bothers or distracts. Americans are eager to believe in the panaceas offered in the six drug commercials that regularly accompany each evenings news. We are told—and want to believe—that we can swallow a pill and soon be dancing on a dinner cruise, running on the beach, or playing football like John Elway, the former NFL quarterback and promoter of Prevacid, a heartburn pill. If we eat too many cheeseburgers and fries, there is comfort knowing one pill will settle our stomachs while another brings our cholesterol back down.

In the condos of Palm Beach, the bungalows of Los Angeles, and the farmhouses of Iowa, people are taking more and more pills. The average American collected more than twelve prescriptions from his pharmacy in 2006, up from eight prescriptions in 1994. Older Americans take home even more—an average of thirty prescriptions each year.

In 2003 Secretary of State Colin Powell explained the nations new prescription habit to a journalist for the Arabic newspaper Asharq Al-Awsat.

“So do you use sleeping tablets to organize yourself?” asked the writer, Abdul Rahman Al-Rashed.

“Yes. Well, I wouldnt call them that,” Powell replied. “Theyre a wonderful medication—not medication. How would you call it? Theyre called Ambien, which is very good. You dont use Ambien? Everybody here uses Ambien.”

There is a problem, however, with the new American way, one that the drug companies and doctors prescribing the medicines do not like to talk about. Experts estimate that more than a hundred thousand Americans die each year not from illness but from their prescription drugs. Those deaths, occurring quietly, almost without notice in hospitals, emergency rooms, and homes, make medicines one of the leading causes of death in the United States.

On a daily basis, prescription pills are estimated to kill more than 270 Americans—more than twice as many as are killed in automobile accidents. Prescription medicines, taken according to doctors instructions, kill more Americans than either diabetes or Alzheimers disease.

America has become “a grossly overprescribed nation,” says Dr. Arnold Relman, professor emeritus at Harvard Medical School and the former editor of The New England Journal of Medicine. “Again and again you see examples where patients get far more medication than they need. The average senior in America is probably taking twice or three times the medications they require.”

Doctors prescribe one drug only to create new problems for the patient with the pills side effects. Rather than realize the medicine is making them ill, patients believe they are just getting old and ask for even more pills. Arthritis patients get pain relievers, which raise their blood pressure. At their next visit, doctors prescribe medicines for hypertension, which come with a whole new set of adverse effects.

It is estimated that the nation 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.

Despite these injuries and deaths, the medicine merchants have not stopped with adults. They are now targeting the increasingly profitable and fast-growing medicine market for children. The companies marketers have created storybooks, video games, and soft, cuddly toys to attract childrens attention. They have also learned to aim their appeals at parents desire to have the perfect child. Parents of short children are told that daily injections of human growth hormone can help their son grow inches and be better accepted by his peers. They are told that Ritalin will help their daughter get higher grades. An antidepressant, they learn, may help their shy child play with other kids. In 2002 and 2003 prescription spending rose faster for children than for seniors, baby boomers, or any other group.

But so far scientists know little about the long-term effects of using powerful adult drugs in children, making the booming pediatric market a grand American experiment. The drugs have already harmed thousands of children. Federal regulators received more than seven thousand reports of drugs harming infants and toddlers under age two between 1997 and 2000, according to a university study. More than 750 of those children died.

 
 
The vast majority of the industrys marketing dollars is directed not at consumers but at physicians, the gatekeepers whom patients trust. In 2004 the industry employed an army of 101,000 sales representatives to call on those doctors—two and a half times the size of its sales force in 1995. There is now one drug salesperson for every six physicians, each with an expense account that lets him shower doctors with gifts and cash. Surveys show that virtually every American physician now takes these handouts.

Sales representatives at a company called Tap Pharmaceutical Products gave frequent prescribers of its medicine Lupron television sets and VCRs for their offices and tickets to Broadways Phantom of the Opera. When a doctor asked the drug company to pay to relocate his office, Taps executives wrote a check. When physicians wished they could earn more money, Tap paid up to $25,000 for consultants to guide them on how to be better businessmen.

A training manual for Taps salespeople explained they should expect doctors and hospitals to ask them for cash. The sales reps could deliver the money, the manual directed, as long as they remembered that “the primary factor” was “what will the grant do for you and your company.” The company expected doctors receiving the gifts to return the favor by writing more prescriptions. “If a non-user physician asks for money,” the manual instructed, referring to doctors who did not prescribe Taps products, “ask for scripts.”

By the beginning of the twenty-first century, doctors had come to count on the industrys handouts. “Its nice after an exhausting day at work to go to a dinner, sporting event or spa where we can discuss with our peers and learn more about treatments for various diseases,” wrote Dr. Nancy Sika and Dr. Colleen Heniff in a letter to federal officials in 2002 when the government proposed restricting some of the gifts. “Why are we singled out by the government not to have the same perks as other businesses?

“As physicians we are a very ethical, intelligent group,” they wrote. “I have not seen us be swayed to use a product just because we were taken out.”

But patients tell stories of how their doctors gave in to the sales pitches. Mrs. Albert F. Rust of Kirtland Hills, Ohio, said she was horrified as she watched a doctor switch her elderly mother to a new drug that was heavily promoted from one that seemed to be helping her. “The representative of the company has been after me to switch my patients,” the doctor had explained.

“We were helpless,” Mrs. Rust said. “I cried and so did Mom. She was 87 years old and a timid elderly person. I wont forget her confusion and sadness.”

 
 
Because only about 10 percent of the price of most brand name pills goes to cover the cost of the raw chemicals and manufacturing, the industry has plenty left even after paying for advertisements, research, and the high salaries and expensive perks of its executives. While patients and taxpayers have been left with emptied pockets, the drugmakers have been flush with cash. From 1995 to 2002 they were the nations most profitable industry. In 2004 the pharmaceutical companies turned nearly sixteen cents of each dollar of revenue into profit, according to Fortune magazine. That compares with the median profit earned by Americas five hundred largest public companies that year of a little more than five cents.

With their hoards of cash, the companies have readily handed money to patient groups, hospitals, universities, medical schools, physician societies, government agencies, and just about any organization they want on their side. Harvard, for one, has a lecture hall named for Pfizer in a building named for Mallinckrodt, another company.

The industrys cash-filled coffers have given it a stranglehold on medical science. Most of the nations best academic medical minds have at some time been on the industrys payroll as consultants. As the drug companies influence has grown inside our universities, research priorities have abruptly shifted to hurt the publics interest. Professors see more money in working on the next blockbuster heartburn medicine than in studying the environmental causes of cancer. They and the companies that financially support them are more interested in developing hair loss treatments and other lifestyle drugs for rich Americans than in discovering cures for diseases like malaria, which is devastating poor countries and killing a child every thirty seconds.

The drug companies chain of influence is so complete that there are few people left to look objectively at the effects of their products on the nations health or at the consequences of their power for society.

Washington is the axis of the industrys power. The pharmaceutical companies spent more on lobbying between 1998 and 2004 than any other industry. By 2004 the companies employed a legion of lobbyists so large there were more than two for each member of Congress. By using their wealth to buy influence, the drug companies have repeatedly squelched attempts to regulate their prices and promotional practices. The United States is the only developed country in the world that does not control prescription drug prices. Only the United States and one other country, New Zealand, allow drugmakers to advertise to consumers. The industry has also won new laws that have added years to the average length of time their products are protected from competition by patents. Another law allowed the companies to profit from medical discoveries made by taxpayer-funded scientists. And when these new measures boosted the drug companies profits, other laws gave them tax credits so lucrative that as a group they pay far lower taxes on average than other major industries.

Overall, the pharmaceutical industry has created a market for its products in the United States in which ordinary economics no longer apply. Patients do not get the best medicines for their ailments at the best prices. Instead, Americas medicine market is one where more  competition can mean prices will rise rather than fall. It is also a mar- ket in which patients suffer when they get the wrong drug because      the industrys powerful promotional forces have distorted the available medical information. No one knows how many people are swallowing expensive new pills when older, far cheaper drugs that are not promoted would be best.

 
 
Medicines can and do save lives. Antibiotics, first sold in the 1940s, have saved millions of people from infections that otherwise would have been fatal. Vaccines have virtually wiped out diseases like polio. Children with leukemia can now survive into adulthood because of medicines discovered in the decades following World War II. In the 1990s protease inhibitors and other antiviral drugs sharply reduced the death rate from AIDS. The drug marketers have told us these stories over and over.

The tragedy lies not with the medicines but with the marketing and the unprecedented power these companies now have over the practice of medicine. Weve come to a time when decisions on how to treat a  disease have as great a chance of being hatched in a corporate marketing department as by a group of independent doctors working to improve the publics health. In too many cases, whether a medicine helps or harms a patient has become secondary to how much it will bring   shareholders in profits. That is the story of this book, the one that   doesnt get told.

In its broadest terms, this book is about how Americas for-profit medical system—filled with incentives to make money and disincentives for good care—has failed. While we are swallowing too many pills, we are also undergoing unneeded surgeries, X-rays, and CT scans. The companies striving to sell us as many pills, medical devices, and hospital stays as possible have goals that conflict with a basic tenet of medical intervention: do not overtreat.

Instead, the medical marketers of the twenty-first century work by the advice given to displaymen employed by the nations department stores in the early 1900s as they learned to seduce the masses into buying more shirts, dresses, and toys.

“Sell them their dreams,” a radio announcer urged a convention of displaymen in 1923. “Sell them what they longed for and hoped for and almost despaired of having . . . Sell them this hope and you wont have to worry about selling them goods.”

Like the displaymen before them, the medicine merchants have learned to sell us our hopes and dreams, a pill for our every desire. Too few of us realize the dangers.

 

Excerpted from Our Daily Meds by Melody Petersen. Copyright © 2008 by Melody Petersen. Published in March 2008 by Sarah Crichton Books, a division of Farrar, Straus and Giroux, LLC. All rights reserved.

Product Details

ISBN:
9780312428259
Author:
Petersen, Melody
Publisher:
Picador USA
Subject:
Health Care Issues
Subject:
Health Care Delivery
Subject:
Pharmacology
Subject:
Drugs -- United States -- Marketing.
Subject:
General
Subject:
Health and Medicine-General
Copyright:
Edition Description:
Trade Paper
Publication Date:
20090331
Binding:
TRADE PAPER
Grade Level:
General/trade
Language:
English
Illustrations:
Includes notes, a bibliography, and an i
Pages:
448
Dimensions:
8.3 x 5.5 x 0.81 in

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Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescri Used Trade Paper
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Product details 448 pages Picador USA - English 9780312428259 Reviews:
"Synopsis" by , "Our Daily Meds" shows how corporate salesmanship has triumphed over science inside the biggest pharmaceutical companies and, in turn, how this promotion-driven industry has taken over the practice of medicine.
"Synopsis" by ,

An “angrily illuminating” (The New York Times) exposé of Big Pharmas corrupting influence in America today

In the last thirty years, pharmaceutical companies have seized control of American medicine by putting their marketers in charge. They invent diseases in order to sell the pills that "cure" them. They sway doctors by giving them resort vacatopms, gourmet meals, and fistfuls of cash. They advertise prescription drugs at NASCAR races, on subways, and even in churches. Medicines can save lives, but the relentless promotion of these products has come at tremendous cost. Prescription pills taken as directed are estimated to kill one American every five minutes. More Americans are addicted to medications than cocaine. And roads have become less safe as the over-medicated take to the wheel. In Our Daily Meds, journalist Melody Petersen connects the dots to show how subtle, far-reaching, and dangerous Big Pharma's powers have become.

Melody Petersen covered the pharmaceutical beat for The New York Times for four years. In 1997, her investigative reporting won a Gerald Loeb Award, one of the highest honors in business journalism. She lives with her husband in Los Angeles.
A Finalist for the Helen Bernstein Book Award for Excellence in Journalism

In the last thirty years, the big pharmaceutical companies have transformed themselves into marketing machines selling dangerous medicines as if they were Coca-Cola or Cadillacs. They pitch drugs with video games and soft cuddly toys for children; promote them in churches and subways, at NASCAR races and state fairs. Theyve become experts at promoting fear of disease, just so they can sell us hope.

 
There is no doubt that pharmaceutical drugs can save lives. But the relentless marketing that has enriched corporate executives and sent stock prices soaring has not come without consequences. Prescription pills taken as directed by physicians are estimated to kill one American every five minutes. And that figure doesnt reflect the damage done as the overmedicated take to the roads.
 
In Our Daily Meds, Melody Petersen connects the dots to show how corporate salesmanship has triumphed over science inside the biggest pharmaceutical companies and, in turn, how this promotion driven industry has taken over the practice of medicine and is changing American life. She shows how an industry with the promise to help so many is leaving a legacy of needless harm and potentially life-changing consequences for everyone, not just the 65 percent of Americans who unscrew a prescription cap every day.
"Everyone talks about health care, but few ask why we're so sick to begin with. Melody Petersen's book goes a long way toward explaining that the people who came up with the 'cures' are actually the problem."Bill Maher, Real Time
"An angrily illuminating book on drug-related corporate malfeasance and patient peril . . . tough, cogent and disturbing . . . [A] chilling investigation."Janet Maslin, The New York Times

"A fascinating introduction to one of the most powerful industries of our time."Shannon Brownlee, The Washington Post

 
"Sobering, scrupulously researched . . . We have no choice but to take careful heed."The Boston Globe
 
"Everyone talks about health care, but few ask why we're so sick to begin with. Melody Petersen's book goes a long way toward explaining that the people who came up with the 'cures' are actually the problem."Bill Maher, Real Time

"Full disclosure: Not long ago I worked as one of a small army of associates defending pharmaceutical products liability cases. As one fellow lawyer put it, we were 'making the world safe for giant pharmaceutical companies.' Much of my time was spent reviewing marketing for the drug at issue. Given that, I read Our Daily Meds, by former New York Times writer [Petersen] with no small measure of interest. The subtitleHow the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugsgives a small hint of the book's attitude toward big pharma. And given how easy a target drugmakers are, I was expecting somewhat of a hatchet job. Instead, I found myself thoroughly persuaded by Petersen's book. She presents a cogent, well-researched argument that pharmaceutical companies, under pressure from investors, have become supremely focused on developing 'blockbuster' billion-dollar-a-year drugs . . . Petersen's indictment of the pharmaceutical companies, and more surprisingly, the doctors who play along, is damning. She describes how doctors are treated to all-expense-paid conferences at resorts and hotels by the drug companies and then complain when they're not chauffeured to and from, or when there's inadequate entertainment for their children. Or doctors are paid to let their names be listed as authors on articles in medical journals written by pharmaceutical companies, copies of which are then distributed to other doctors by the company's marketers as though they're independent confirmation of the drug's safety and efficacy . . . Attorneys who may have touched one of the numerous product liability lawsuits against pharmaceutical companies and their products will likely find this book extremely interesting. But non-lawyer healthcare consumers will also gain a tremendous amount from this well-researched book."Fabio Bertoni, New York Law Journal Magazine  

"A devastating, often shocking, critique of a once proud industry that has been converted by corporate greed into a vast marketing machine that is often a menace to health. Petersen supports her indictment with an abundance of fascinating detail and human interest stories. An excellent contribution to the growing demand for better regulation of an industry that has grown way too powerful and heedless of the interests of its customers."Marcia Angell, M. D., Senior Lecturer in Social Medicine, Harvard Medical School and Arnold S. Relman, M. D., Prof. Emeritus of Medicine and of Social Medicine, Harvard Medical School

"A no-punches-pulled indictment of the pharmaceutical industry in the United States. Big Pharma has been making money but doing harm ever since it shifted a quarter-century ago from research to marketing, asserts Petersen, a business reporter for The New York Times . . . These 'medicine merchants,' she charges, sell their products with slick television ads aimed at adults and appealing cartoon characters aimed at children; their advertising is ubiquitous, showing up everywhere from NASCAR races and state fairs to churches and spiritual guides. Big Pharma has gained unprecedented power over the practice of medicine, Petersen contends, spending enormous amounts of money to entice doctors into prescribing its products and turning medical continuing-education courses into virtual sales bazaars. The drug companies now have 'a stranglehold on medical science.' They form alliances with universities; research studies are paid for by the industry; and articles and editorials ghostwritten by PR firms appear over the names of academics. Petersen names specific pharmaceutical companies, executives and drugs, devoting entire chapters to the marketing of Detrol, Ritalin, Neurontin and Zantac. The harm they do to the public is not just economic, she notes; Amer

"Synopsis" by ,

An “angrily illuminating” (The New York Times) exposé of Big Pharmas corrupting influence in America today

In the last thirty years, pharmaceutical companies have seized control of American medicine by putting their marketers in charge. They invent diseases in order to sell the pills that "cure" them. They sway doctors by giving them resort vacatopms, gourmet meals, and fistfuls of cash. They advertise prescription drugs at NASCAR races, on subways, and even in churches. Medicines can save lives, but the relentless promotion of these products has come at tremendous cost. Prescription pills taken as directed are estimated to kill one American every five minutes. More Americans are addicted to medications than cocaine. And roads have become less safe as the over-medicated take to the wheel. In Our Daily Meds, journalist Melody Petersen connects the dots to show how subtle, far-reaching, and dangerous Big Pharma's powers have become.

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