The big sting

Originally published 21 November 2004

I have my annu­al phys­i­cal tomor­row, and I have a list of things to ask my doc­tor about: Allegra‑D, Ambi­en, Nex­i­um, Cele­brex, Via­gra, Lip­i­tor, etc., etc. I’m not even sure what all these drugs are for, but accord­ing to the ads I watch on TV, I’m sup­posed to ask my doc­tor if they are right for me.

OK, just kid­ding. I have no list. I don’t want my doc­tor to take me as a fool. But appar­ent­ly the big phar­ma­ceu­ti­cal com­pa­nies take us all for fools, because they spend bil­lions of dol­lars a year try­ing to con­vince us that we need drugs for mal­adies we don’t even know we have.

The phar­ma­ceu­ti­cal indus­try bud­gets $30 bil­lion for sci­en­tif­ic research and devel­op­ment, and $54 bil­lion for mar­ket­ing. The shame­less hawk­ing of pre­scrip­tion drugs, in par­tic­u­lar, is one of the biggest scan­dals of our time.

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.”

Who pays for all the unnec­es­sary adver­tis­ing? The con­sumer, of course, espe­cial­ly Amer­i­can consumers.

I live part of each year out­side of the States, and I can tell you that Amer­i­cans spend far more for med­i­cines than any­one else in the world. We are being sys­tem­at­i­cal­ly tak­en to the clean­ers by the big phar­ma­ceu­ti­cal com­pa­nies, with the con­nivance of government.

For exam­ple, the present admin­is­tra­tion’s much tout­ed Medicare reform bill, with its pre­scrip­tion ben­e­fit for seniors, for­bids Medicare to bar­gain on prices, a big fat treat for the phar­ma­ceu­ti­cal indus­try. No won­der so many seniors and local health pro­grams buy drugs from Cana­da or off the internet.

In short, an indus­try whose focus should be on sci­ence has sur­ren­dered to greed.

The biggest losers are the poor­est peo­ple in the world, who can­not get access to the retro­vi­ral drugs they need to com­bat AIDS. Malar­ia, tuber­cu­lo­sis, sleep­ing sick­ness, menin­gi­tis, Buruli ulcer, and oth­er dis­eases of the poor require research and devel­op­ment. Effec­tive, user-friend­ly con­tra­cep­tives are a press­ing need.

The sci­ence is there to address these needs, in acad­e­mia and pub­lic lab­o­ra­to­ries, but the phar­ma­ceu­ti­cal indus­try picks its projects on the basis of easy prof­it. It would rather invest obscene amounts of mon­ey pro­mot­ing a few high­ly prof­itable drugs to Amer­i­can baby-boomers who might not need them, than use those same funds to fight, for exam­ple, malar­ia, the world’s num­ber one killer of children.

Of course, no one is ask­ing the indus­try to run in the red. The com­pa­nies will say in their defense that they are respond­ing to mar­ket forces, and they are right. Which is why the entire health care indus­try in this coun­try — doc­tors, hos­pi­tals, insur­ers, and drug com­pa­nies — must be stream­lined, inte­grat­ed and brought to heel by some degree of gov­ern­ment con­trol, some­thing the Clin­tons tried to do before they were run over by a loco­mo­tive of self-interest.

What’s all this got to do do with sci­ence? Plen­ty. Breath­tak­ing recent devel­op­ments in genomics, pro­temics (pro­tein sci­ence), and com­pu­ta­tion open up pos­si­bil­i­ties for a new epoch of drug devel­op­ment, with empha­sis on des­per­ate­ly need­ed antimi­cro­bials and vac­cines. Open any week­ly issue of Sci­ence or Nature and you will mar­vel at the detail with which sci­en­tists are now able to under­stand and manip­u­late the mol­e­cules of life.

Drug-mak­ing is no longer a mat­ter of tri­al and error. We are gain­ing an increas­ing under­stand­ing of how infec­tious agents wreak their dam­age. The path is open to alter the land­scape of world health. All we lack is gen­eros­i­ty of spir­it and polit­i­cal will.

The drug com­pa­nies see their eco­nom­ic future in a few block­buster drugs, like Nex­i­um and Via­gra, rather than in drugs that might elim­i­nate or dras­ti­cal­ly alle­vi­ate malar­ia, tuber­cu­lo­sis, and oth­er killer dis­eases of the devel­op­ing world.

So here’s some­thing to ask your doc­tor about. Ask your doc­tor to give the boot to the 88,000 sales­men assigned by the drug com­pa­nies to cajole and bribe them into pre­scrib­ing their expen­sive drugs.

And while you’re at it, ask your rep­re­sen­ta­tives in Con­gress if ignor­ing the world’s poor­est in favor of cor­po­rate prof­it is right for them.