Are the drug companies determining the depth and breadth of medical research for the purposes of profit? There may be evidence that brings one to that conclusion.
Charles Seife, writing in Scientific American, contends “In the past few years the pharmaceutical industry has come up many ways to funnel large sums of money—enough sometimes to put a child through college—into the pockets of independent medical researchers who are doing work that bears, directly or indirectly, on the drugs these firms are marking and marketing.”
It's no small accident that pharmaceutical companies have grown so large-their profitability is astounding. In 2001, U.S. pharmaceutical company profits averaged 18.5% of revenue compared with 2.2% for the rest of the Fortune 500 companies (Fortune magazine, April, 2002). Imagine what the figures are today.
Drug manufacturers spend billions yearly on marketing and advertising, far beyond what they spend on research. Billions go into direct to consumer advertising which drums a mantra to the masses: "ask your doctor if (___ medication) is right for you." Billions are poured into marketing to doctors, including via drug sales reps - one of the most lucrative sales jobs in the U.S.
Psychiatric drugs are notoriously high-priced. A journal article in Biosocieties, entitled, "Demythologizing the high costs of pharmaceutical research," exposes that drug companies widely exaggerate research costs to justify these prices. These companies typically cite a 2003 industry-funded study to claim a tag of over $1 billion to research and bring a drug to market. A new independent analysis indicates the figure is closer to $55 million.
The drug companies leave nothing to chance in their marketing plans however, making pitches directly to consumers. Of all western nations only in the United States and New Zealand, are drug companies are permitted to advertise their products directly to consumers. In the year 2000 alone, 2.5 billiondollars was spent on advertising prescription drugs to consumers in the United States (Public Citizen, 2002). In 1999, it was estimated that the average American saw nine advertisements for drugs every day. There is no doubt that direct to consumer advertising leads to increased prescription of drugs. A recent survey showed that one in five Americans was prompted to call or visit their doctor to discuss an advertised drug (BMJ, News, October, 2002).
Drug company corporate websites tell us of their integrity and utmost commitment to people's health and well-being. The American Psychiatric Association's website begins with "Healthy Minds. Healthy Lives" and asserts the "highest ethical standards of professional conduct." Yet there's lots of evidence that points to a different picture.
Thirty-eight state attorneys won a $68.5 million settlement with pharmaceutical titan AstraZeneca for unlawful marketing of antipsychotic Seroquel for unapproved use. These states also charged this company with failing to disclose the drug's harmful side effects and concealing negative information about its safety and efficacy.
Looking further, it's evident that the pharmaceutical industry is fraught with fraud. For instance, the new generation of antipsychotics is the single biggest target of the False Claims Act. Every major drug company selling the drugs has either settled recent government cases for hundreds of millions of dollars or is under investigation for health care fraud. U.S. federal prosecutors are seeking about $1 billion to resolve a long-running probe into Johnson and Johnson's marketing of the antipsychotic drug Risperdal, for off-label marketing of the drug. In 2009, Pfizer reached the drug industry's biggest settlement, agreeing to pay $2.3 billion to resolve an investigation into the marketing of now-withdrawn painkiller Bextra. Since 2001, drug makers have paid more than $11 billion in off-label marketing and other whistleblower fraud cases.
Drug companies also have an impact on governments and social policy. The industry seeks direct influence at a government level by employing political lobbyists and contributing large sums of money to political parties and campaigns. In the United States, there are more pharmaceutical industry lobbyists than Congress members. The lobby budget for 1999 and 2000, at $197 million dollars, was $50 million dollars larger than the drug industry's nearest rivals, the insurance and telecommunications industries. On top of this, the industry makes generous contributions to election campaigns, mostly to Republican Party candidates (New York Times, 4th November, 2001). Imagine what the figures must be like today.
Charles Seife, in his Scientific American article, goes on to say “The problem is not just with the drug companies and the researchers, but with the whole system—the granting institutions, the research labs, the journals, the professional societies, and so forth. No one is providing the checks and balances necessary to avoid conflicts. Instead, organizations seem to shift responsibility from one to the other, leaving gaps in enforcement that researchers and drug companies navigate with ease, and then shroud their deliberations in secrecy.” Seife argues that peer-reviewed scientific journals contain numerous articles that show how drug industry money is undermining scientific objectivity.
So what’s the solution? Seife argues for greater transparency in independent research, requiring for example, that journals, grant-making institutions and professional organizations require researchers to openly declare when they have any connections that might compromise their objectivity, “That way the scientific community decides whether a study is ethical and when the experiment is done, how far to trust the results.”
Efforts have been made by the U.S. Congress to stop the corruption in medical research, by incorporating into the 2010 health care reform act the Physician Payments Sunshine Act that requires all drug companies and medical device companies to reveal most of the money they are putting in the pockets of physicians. Yet Seife is not optimistic that this enough: “Researchers cannot stop the influence of drug company money. Hospitals and universities will not do it. The NIH refuses to do it. And as a result, millions of taxpayer dollars fund research whose objectivity is being undermined.” Seife concludes that the only hope of solving the conflict of interest problems lies with the researchers themselves by not depending on drug company money.
The situation is analogous to the alliance of Wall Street bankers and traders, who with the help of some esteemed economists, established acceptance of a rationale for a financial system of great benefit to them personally. In the end, the one-sided nature of the transactions led to an economic crash causing great financial losses for the public. Similarly, psychiatry and drug companies have perpetrated a utopian pharmaceutical mythology that serves their interests very well but has served the public very poorly.
It may be up the general public to become far more aware of the extent of the problem and pressure lawmakers to do something about it.