B Big Pharma

PUSH Post

25 October 2008

Public United for Savings in Healthcare

Big Pharma blues

About the biggest in the business world • Sales > 2 billion/ year • Transnational operations • R & D in at least 5 different therapeutic areas • Fully vertically integrated operations • The top 20 Big Pharma companies represent almost 60% of the world pharma market.

What is "Big Pharma"? "Big Pharma" is the collective name for a small group of pharmaceutical business houses - about 20 in number - that dominate the drugs and pharmaceutical scene globally. Being businesses, they place profit before all else, including the best interests of patients. Health care costs keep rising endlessly. The expenditure on drugs is irksome, particularly when viewed against the background of enormous profits that the pharmaceutical industry reports year after year. The industry is entirely in private hands; governmental efforts have been abandoned everywhere. Being businesses, profits boil down to the common axiom: size matters. Driven by mergers and acquisitions (evidenced by the concatenated and hyphenated names), the industry is dominated by a group of around 20 companies, collectively known as "Big Pharma". Big Pharma's sensitivity to patient and customer concerns has been scrutinized in recent years and found to be distressingly callous. Their dealings are seldom open or transparent: murkiness, deception and unwholesome nexuses abound.

Source: Michael Rosen, June 13, 2005. http://wistechnology.com/articles/1903/

Profits or profiteering

Despite claims of being a high-risk business, the industry reports huge profits year after year. It remains firmly entrenched in the #1 spot for profits returned on revenues (almost 20%), a figure that is 6 times the average for big business as a whole.

Industry exaggerates costs of drug development New drug discovery costs us big money

So you say!

The doctor-pharma nexus The heavy hand of Big Pharma The heavy (other) hand ... Pharm Free - Revenge of the Jedi

Much more at:

Several reasons are offered to justify the need for these large profits, most of which do not bear up to careful examination. "New drug discovery is an expensive affair." The industry claims that it takes about 800 million to a billion US dollars for each drug that is brought to market. On close inspection, the argument fails to hold up.

© Dr Arjun Rajagopalan

•A large portion of this amount is spent on expensive, barely ethical, drug promotion rather than research. Besides samples of drugs, small gifts are almost always passed across the table: pens, note pads, calendars and other gee gaws. It does not stop here. Trips are sponsored for conferences and updates, most of which are obvious junkets. •Most often, the basic research on a compound is done by government-funded research efforts. The pharma industry takes over when it senses something likely to be profitable. It is seldom interested in drugs that are useful for rare (orphan) diseases or those that are seen mainly in poor countries of the developing world. •So called "new" drugs are often mere extensions of existing compounds. This prolongs the patent protection benefits and allows high costs to be maintained with dubious benefit to the patient. Quite clearly, Big Pharma's profits are unpalatable.

25 October 2008

The doctor-pharma nexus "Doctors no less than their patients are being led along by Big Pharma. Research is sponsored by Big Pharma, and only now are these funding sources mentioned in scientific journals alongside findings. Conferences, seminars, calendars, pads, pens, clipboards, anatomical diagrams, plastic replicas of organs – and even the Friday afternoon staff pizza – are being paid for by Big Pharma." ... "What is the value of empowerment when one is provided a few highly selective facts in a gauzy, feel good frame? One remembers the emotion and the drug name, and probably little else." Below the Fold: Pitching Prescriptions and Patient Empowerment. Michael Blim. July 30, 2007 http://3quarksdaily.blogs.com/3quarksdaily/2007/07/belowthe-fol-1.html

"Their power, in relation to all of the forces that might oppose their will, is so disproportionately huge that they can dictate how they are to be (lightly) regulated, shape much of the medical research agenda, spin the findings in their favor, conceal incriminating data, co-opt their potential critics, and insidiously colonize both our doctors' minds and our own". Talking Back to Prozac. By Frederick C. Crews. The New York Review of Books. Volume 54, Number 19 · December 6, 2007. Financial ties and concordance between results and conclusions in meta-analyses: retrospective cohort study. Veronica Yank, Drummond Rennie, Lisa A Bero. BMJ 2007;335:1202-1205 (8 December) http://www.bmj.com/cgi/content/full/335/7631/1202?rss=1 Objective: To determine whether financial ties to one drug company are associated with favourable results or conclusions. Conclusion: ... are not associated with favourable results but are associated with favourable conclusions.

Machiavelian tactics received worldwide coverage. Big Pharma commonly chooses to be economical with the truth. Nothing demonstrates this behavior as dramatically as the recently published article on the efficacy of Prozac (fluoxetine) - the widely prescribed drug for the treatment of depression.

Big Pharma's reach is Orwellian. Its power penetrates areas that should be immune to the machinations of the industry. The very mechanisms that are in place to control it are infiltrated by its overwhelming financial clout. Horror stories are legion. Advances in Medicine are reported and criticised in peer-reviewed journals, believed to be unncorruptible guardians of scientific truth. These journals need advertising support to remain financially viable. Pharma houses are the main advertisers and have been shown to use this leverage to their advantage. Positioning of ads next to favorable reports, ordering "reprints" in bulk, and taking subscriptions on behalf of doctors are some of the common methods by which Big Pharma keeps medical publishing beholden to itself. In recent years, more vicious practices have been brought to light. In one memorable instance, a leading specialist journal was asked to refrain from publishing an article that showed little or no benefit from the use of a widely prescribed drug. The makers of the drug were the largest advertisers in the journal and they threatened to pull out their advertising if the article ran. The editorial board buckled and held the article back. This shameful behavior was "leaked" to an eminent medical editor who ensured that the conduct of the pharma house

The authors of this study - a firstof-its-kind analysis - obtained a full set of trial data from the Food and Drug Administration for four antidepressants under freedom of information rules. The study included results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill. When the data was put together, it appeared that patients had improved - but those on placebo improved just as much as those on the drugs. The authors conclude: "... we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance ..." Prozac - a "blockbuster" drug for its manufacturer - accounts for almost a quarter of the revenues of this 10-billion-dollar Big Pharma house. Since its launch in 1988, close to 40 million people have taken Prozac. Source: Kirsch I, Deacon BJ, Huedo-Medina TB, et al. (2008) Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 5(2): e45. doi:10.1371/journal.pmed. 0050045

PharmFREE This one is reminiscent of the first Star Wars movie: the one where the good guys have been driven to a remote, god-forsaken place in the galaxy by the all pervading power of The Empire. The story starts with the avowed ideals of the medical profession "being threatened by the lavish trips, gifts, and fancy meals that pharmaceutical companies were providing doctors to change their prescribing habits." The initiative described in this article is akin to Luke Skywalker being mentored by Ben Kanobi. "Pharm Free" is the light sabre that the good Jedi are distributing to medical students and other early entrants into Medicine. It is an educational campaign that is "...encouraging all physicians-in-

training and health-care providers to seek out evidence-based and unbiased sources of information, rather than relying on industry personnel for education. "Vision: [Pharm FREE] "envisions a day when pharmaceutical companies are able to dedicate their resources to creating drugs that physicians choose to use because they are effective in treating disease, not because they are effectively marketed. We envision a day when every medical student and physician is aware of the professional, ethical and practical complications of the current relationship with pharmaceutical company representatives. We envision a day when physicians demand integrity, honesty, and education (not biased information) from members of their profession, for the sake of our patients and their trust in us."

© Dr Arjun Rajagopalan