Pushing drugs

Originally published 2 December 2007

Two peo­ple I’d be hap­py to nev­er see in the media again: Robert Bazell and Robert Jarvik.

Bazell is the Chief Sci­ence and Health Cor­re­spon­dent on NBC Night­ly News. He’s a good reporter and no doubt means well, but his earnest night­ly procla­ma­tions from the world of health research stand for every­thing I hate about Amer­i­can net­work news. Ten min­utes of real news, ten min­utes of Big Pharm ads, and ten min­utes of Mr. Bazell feed­ing us the lat­est med­ical mir­a­cle: “A new study announced today in the New Eng­land Jour­nal of Med­i­cine shows that drink­ing 6 ounces of cucum­ber juice a day can reduce the inci­dence of pso­ri­a­sis by two per­cent.” OK, I made that up, but it sounds famil­iar, does­n’t it? Maybe one out of five of Bazel­l’s sto­ries are as impor­tant as the least sig­nif­i­cant news sto­ry on BBC Amer­i­ca. Part of this is sure­ly the net­works play­ing to their health-obsessed baby-boom audi­ence. But the health obses­sion of baby boomers goes hand in hand with the bil­lions of dol­lars Big Pharm spends nur­tur­ing that obses­sion. Robert Bazell is the face of the net­works giv­ing up on real news.

If you’re an Amer­i­can and don’t know who Dr. Robert Jarvik is you’ve been liv­ing under a rock. He’s sure­ly the hottest prop­er­ty of the Big Pharm mar­keters. Just look at all those full-page spreads in the news­pa­pers. “Inven­tor of the Jarvik arti­fi­cial heart and Lip­i­tor user.” His smug face is enough to give me a heart attack. Big head­line: “Lip­i­tor reduces risk of heart attack by 36 per­cent.” Wow! Small­er print: “That means in a large clin­i­cal study, 3 per­cent of [high risk] patients tak­ing a sug­ar pill or place­bo had a heart attack com­pared to 2 per­cent of patients tak­ing Lipitor.”

In his book, Over­dosed Amer­i­ca, Dr. John Abram­son of Har­vard Med­ical School looks care­ful­ly at the stud­ies cit­ed as evi­dence for the effec­tive­ness of cho­les­terol-low­er­ing meds such as Lip­i­tor (statins). His con­clu­sion: The drugs are vast­ly over­pre­scribed, to no one’s ben­e­fit but Big Pharm. Which is where Dr. Jarvik comes in. If Mr. Arti­fi­cial Heart flash­es his mug as a stamp of approval, then every­one who reads the news­pa­per or watch­es TV should rush right out and ask their doc­tor for Lipitor.

Don’t get me wrong. I’m not anti drugs or Big Pharm. I was supreme­ly glad for antibi­otics last year when I got Lyme dis­ease. If I had AIDS or if I were chron­i­cal­ly depressed, would I be on drugs? You bet. Sci­en­tif­ic drug devel­op­ment has trans­formed civ­i­liza­tion, increased longevi­ty and qual­i­ty of life. Dozens of mor­tal dis­eases have been checked by vac­cines and drug ther­a­py. It’s not drugs but drug mar­ket­ing that makes me and lots of oth­er folks uneasy. Every time I see an ani­mat­ed toe­nail grem­lin or talk­ing blob of green mucus I lose a bit more respect for what­ev­er authen­tic integri­ty the drug indus­try might have.

Do pre­scrip­tion drugs real­ly need to be called Lyri­ca and Cele­brex? What are they sell­ing? The elixir of bliss? Do the drug com­pa­nies need to flood the media with sun­shine, blue skies, and beau­ti­ful peo­ple stand­ing in fields of daisies to cre­ate a mar­ket for pre­scrip­tion prod­ucts? As Mar­cia Angell, a for­mer edi­tor-in-chief of the New Eng­land Jour­nal of Med­i­cine, writes: “Tru­ly good drugs don’t have to be pro­mot­ed. A gen­uine­ly impor­tant new drug…sells itself.”

Why is it that every Big Pharm sales rep I see enter­ing our local med­ical cen­ter is young, attrac­tive, and per­fect­ly attired in dark, pro­fes­sion­al and — yes — sexy attire, both men and women? In a review of three anti-drug mar­ket­ing books in the cur­rent New York Review of Books, Fred­er­ick Crews talks of how the big drug com­pa­nies “insid­i­ous­ly col­o­nize both our doc­tors’ minds and our own.” What do the vast sums spent on col­o­niza­tion — more than on research and devel­op­ment! — do to the cost of health care in Amer­i­ca? What does the exces­sive use of pow­er­ful drugs do to the over­all health of patients? The Boston Uni­ver­si­ty Med­ical Cen­ter has just placed restric­tions on drug rep vis­its, and the Mass­a­chu­setts leg­is­la­ture is con­sid­er­ing rules requir­ing doc­tors to report any gifts worth over $25. Doc­tors and patients are get­ting fed up. Expect to see nation­al restric­tions soon.

In last Sun­day’s New York Times Mag­a­zine, Dr. Daniel Car­lat, a psy­chi­a­trist, wrote of his recruit­ment by a drug com­pa­ny to edu­cate oth­er doc­tors about that fir­m’s anti­de­pres­sant drug. It was a lucra­tive role, which he ratio­nal­ized on the basis of mar­gin­al data. It was only with time that he real­ized that he had been bought. When he start­ed giv­ing his audi­ence of physi­cians the whole sto­ry he was dumped by his min­ders. One reads this sort of thing with increas­ing frequency.

And yes, I read the oth­er side too, such as Eli Lil­ly CEO Sid­ney Tau­rel’s ring­ing endorse­ment of the indus­try’s com­mit­ment to accu­rate infor­ma­tion in last Tues­day’s Wall Street Jour­nal.

We’re all in this togeth­er, patients and doc­tors, and we rely on each oth­er. Patients espe­cial­ly want to know that their doc­tors are well informed of the pros and cons of every ther­a­py, and have no vest­ed inter­est in any par­tic­u­lar ther­a­py. Doc­tors should­n’t have to deal with patients demand­ing unnec­es­sary drugs they have seen shilled in the media. Who is going to fig­ure out a way to get accu­rate infor­ma­tion to doc­tors and patients while keep­ing the excess­es of drug com­pa­nies in check? There are more Big Pharm lob­by­ists in Wash­ing­ton than there are leg­is­la­tors. As the dis­tin­guished psy­chi­a­trist David Healy has not­ed, Big Pharm does­n’t just bend the rules, it buys the rulebook.

I have tremen­dous respect for my own doc­tor, and I am con­fi­dent there are count­less oth­er physi­cians just like him who want noth­ing but the best for their patients. It is only from them, it seems to me, that real reform can come. They must col­lec­tive­ly purge the most egre­gious mar­ket­ing ploys from the health care sys­tem, and shame the drug com­pa­nies into respon­si­ble ser­vice to the com­mon good.

As I wrote here once before: The beau­ti­ful thing about sci­ence is that it has been rel­a­tive­ly immune to influ­ence by reli­gion, pol­i­tics, eth­nic­i­ty, and the oth­er forces that divide us. It’s a shame that our con­fi­dence in one of the most suc­cess­ful branch­es of sci­ence is erod­ed by greed.