This is the text of the introduction to last week's talk at our branch meeting - many thanks to the comrade who gave this.
If you like what you read here, why not come and join the discussion at our weekly meetings? We meet on Thursdays at 7 pm at the West End Community Centre on Mackworth Road in Derby, next to Britannia Mill. See you there!
Why
Big Pharma Is Bad For Your Health
Introduction
Every
year a handful of the biggest pharmaceutical corporations are
well-represented amongst the most powerful Fortune 500 companies of
the world. Big Pharma’s top eleven
corporations generated net profits in just one decade from 2003 to
2012 of nearly
three quarters of a trillion dollars.
Pharma company Johnson and Johnson
made the most profits of any US company in 2014, making $74.3
billion.
Both
Big Pharma’s highly profitable revenues and absolute economic and
political power in the United States and world are unprecedented.
The profit motive
distorts the type of science that gets carried out and the type of
science that gets prioritized.
For
the last decade, major pharmaceutical companies have relied heavily
on blockbuster drugs to generate sales. Blockbuster drugs are
defined as medicines generating global sales of at least $1 billion
annually. But the industry is in crisis as many of the patents on
these drugs are about to expire, which will mean the market is then
flooded by generic versions of these drugs.
To
get around this company’s create a
“me-2” drug, where they take an existing drug and slightly alter
the chemical formula of it and then market it as a completely new
drug. 75% of drugs approved by the American regulator, the FDA, in
2004 were “me-2” drugs. The FDA will approve a drug that’s
better than placebo.
Drug companies spend
around twice as much on advertising and marketing as they do on
research and development. In America drug
companies spend $4 billion a year advertising directly to consumers
and $24 billion marketing to doctors.
Doctors can’t be
expected to keep on every new development, so they rely on the big
pharma companies for their information on new drugs. These companies
typically promote their new drugs to doctors through drug reps.
There’s approximately one drug rep for every six GPs in the UK.
Drug reps are usually young and attractive, and are well known for
buying doctors free lunches, taking them for out for expensive meals
and giving them free gifts, all paid for by the big pharma companies.
Drug reps take notes on newly qualified doctors to keep track of them
and maintain relationships with them. They also reportedly sometimes
attempt to gain access to areas of hospitals intended for medical
staff only.
When doctors start
to refuse to see drug reps, the pharma companies instead approach
doctors directly and flatter them by telling them they want them to
be a “thought leader”. They’re then paid a lot of money and
given a script written by the drug company, which they then deliver
to an audience who may not realize who has written the talk.
All of this leads to
a massive conflict of interest if a doctor is prescribing a drug
they’ve been paid to promote, it breaks the trust people have in
their GPs to recommend the right medicine for them.
People in regulatory
bodies usually have very close working relationships with people in
the pharma companies, meaning people quickly moving from one side of
the industry to another.
There
is a deep conflict of interest in pharmaceutical companies sponsoring
trials on their own drugs. The pharma industry sponsors 90% of
published clinical trials. A worrying statistic given that, a Ben
Goldacre shows, in
the 192 trials they looked at, industry-funded trials were 20 times
more likely to produce results that favoured the drug.
If
the trial seemed to be producing negative data it is stopped
prematurely and the results were not published, or if it is producing
positive data it may be stopped early so that longer-term effects are
not examined. Many
of the trials that fail to show the results a company had hoped were
typically buried.
As Goldacre argues –
this publication
bias,
where negative results remain unpublished, is endemic within medicine
and academia. As a consequence, he argues, doctors may have no idea
what the effects are of the drugs they prescribe”
This
desire to create profits no matter what leads to cutting corners and
fraudulent methods, which can be lethal for us, the patients.
Fortunately for us medical trial
data now must be fully published, after a change in the law last
year, but this means all the medicine created before then is based on
flawed and incomplete data.
There are many
examples of companies selling drugs they know don’t work, but don’t
want to lose their profits. In 2004, Glaxxo-Smith-Kline, continued
marketing a drug, Paroxetine, to children, which was revealed could
cause them to have suicidal thoughts. The company knew this, yet kept
the drug on the market to keep making profits, until it was caught.
All of the big pharma companies over the years have had to pay out
billions for malpractice and unethical behavior.
Their behavior leads
to conspiracy theories – such as big pharma companies are
withholding treatments to major diseases like cancer. And the rise of
anti-vaccination movement in America, where people are convinced
vaccinations cause autism and in the last two years there’s been an
outbreak of measles (an easily preventable disease) in over 17
states, due to parents not vaccinating their children.
There are also
examples of companies marketing drugs for things they’re not tested
or created for. Because
the drugs are expensive to create, the companies want to try to push
them in as many directions as they can, sometimes with damaging
consequences. The psychotropic drugs, in particular second generation
anti-psychotic (SGA) medications, have been spread far and wide in
this way and further away from their original indication for
schizophrenia-like psychosis.
Finding
a new market for a drug, can mean finding a new problem or a new
disease. Innovation is no longer necessarily driven by a health need;
rather a commercial one.
Some
suggest that big pharma’s strategy has been to invent ‘need
disorders’ like the controversial female sexual dysfunction
disorder (treated with SSRIs). Critics suggest that clinicians are
encouraged by the pharmaceutical industry to develop new diagnostic
categories in which to test efficacy of their compounds and develop a
new market need.
There’s a great
need a new class of antibiotics to cope with new evolving types of
bacteria, which becomes resistant to what we already have. There’s
been no new class of antibiotics since the late 80s.
Furthermore, within
a couple of years, and the organism for which it was developed is now
resistant or the epidemic has reached such proportions in countries
with restricted resources, that the company, for ethical, (we can
safely assume not for conventional business) reasons, is being
impelled to give away its product for free.
Antibiotics,
anti-viral agents and possibly even vaccines, may simply not
represent good business for pharma.
Direct government
intervention is needed to fund research into new antibiotics; it
can’t be left for the market to decide. Antibiotics need to be
using sparingly, to avoid bacteria resistance.
Possible defenses of
the industry
The introduction of
the new law requiring all clinical trial data be published shows the
pharma industry can very occasionally fixes its own problems.
In America a clause
was added to the Affordable Healthcare Act, which meant that lists
are now published online showing all the perks a doctor has received
from any pharmaceutical company. But these are minor tweaks, which
still keep the existing system in place, rather than radically
overhauling it.
Conclusion
Given that the
entire industry revolves around profit as the motive to create new
drugs and treatments, how do we replace this? What other incentives
could motivate people, other than the desire for wealth and status,
to want to cure diseases and make the world safer?
The average UK
person takes 14,000 pills over their lifetime.
Creating something
affordable, which helps people isn’t a good business model for big
pharma.
Western pharma
companies tried to get Indian companies to pay for using generic
versions of their products
Big Pharmaceuticals
could be nationalized and become part of the NHS
Big pharma research
is skewered against neglected tropical diseases, the Ebola virus was
discovered in the 1970s, but work on a vaccine only started recently
after the outbreak
Solutions to
diseases such as TB can’t be solved simply through medicine and
also need greater social interventions, such as better housing
Stop producing so
many Me-2 drugs, stop spending so much on advertising and make all
the data from medical trials available publically, the current
industry prioritizes its profits over everyone’s health
Yellow card scheme -
Notes on Bad Pharma
by Ben Goldacre:
it’s hard to make
a judgment about the effectiveness of a medicine, if only the
positive results are published. Negative results of clinical trials
are frequently not published, and thus people’s understanding is
limited and distorted.
He
writes that
For
example, in a 2007 journal article published in PLOS
Medicine researchers
studied every published trial on statins —
drugs prescribed toreduce cholesterol levels.
“He
writes that these positive results are achieved in a number of ways.
Sometimes the industry-sponsored studies are flawed by design (for
example by comparing the new drug to an existing drug at an
inadequate dose), and sometimes patients are selected in a way that
will make a positive result more likely. In addition, the data is
analysed as the trial progresses.
Producing
positive results in clearly not left down to chance. Some trials are
manipulated by comparing a new drug to inadequate doses of another
drug. In others trial patients are selected in the knowledge that
they will most likely react well to the experimental medication.
Reboxetine,
an anti-depressant drug, was approved for use by the UK’s Medicines
and Healthcare products Regulatory Agency (the MHRA- if you’ve not
heard of it before don’t worry, a 2006 Ipsos MORI survey found 55%
of hospital doctors hadn’t either.)
All
the evidence suggested Reboxetine was a safe and effective treatment.
That is, all the evidence that was actually published.
In
2010, researchers discovered that seven trials had been conducted
testing the drug against a placebo. Nothing unusual there. But only
one trial, the one with positive results, had been published. That
trial dealt with just 254 patients. The other six trials, which
tested on over 2,000 people, all showed that the drug was no better
than a placebo. The negative results never saw the light of day: the
trials were not published.
This
isn’t breaking any rules. Goldacre tells us this is a perfectly
common occurrence.
"Medicine
is broken ... We like to imagine that medicine is based on
evidence, and the results of fair tests. In reality, those tests are
often profoundly flawed. We like to imagine that doctors are familiar
with the research literature, when in reality much of it is hidden
from them by drug companies. We like to imagine that doctors are
well-educated, when in reality much of their education is funded by
industry. We like to imagine that regulators only let effective drugs
onto the market, when in reality they approve hopeless drugs, with
data on side effects casually withheld from doctors and patients....”
– Ben Goldacre
Doctor’s training
funded by the industry
No quality control –
drugs don’t always work properly, have a huge number of side
effects, and yet still get approved
Critique of Bad
Pharma –
“LaMattina
describes his experience on an American talk show, The
Dr Oz Show, during which the host
catalogued, to great audience acclaim, the existence of Four Secrets
That Drug Companies Don’t Want You To Know:
Drug companies
underestimate dangerous side-effects
2.
Drug companies control much of the information your doctor gets
3.
You’re often prescribed drugs that you don’t need
4.
Drugs target the symptoms, not the cause”
The
overall purpose of clinical trials, from a manufacturer’s
perspective, is to collect information to support a drug’s
regulatory approval. If you’re a frequent reader of this blog
you’ll know that there is no shortage of criticism of regulators
for the work they do in evaluating new drugs. One of the biggest is
the challenge of obtaining expert opinion on new drugs from
individuals who may have significant conflicts of interest. This
is a common problem, where those with the most experience using a
drug, are often in direct conflicts of interest, most frequently
because of compensation for participation in clinical trials. The
conflicts that can exist between regulators and the industry it
regulates are real, and probably managed less transparently than we
would like.
Goldacre
spends time describing how regulators worldwide do a generally poor
job of both collecting safety information, but also sharing it with
health professionals and the public. Some of the recommendations he
has to improve regulation includes:
requiring
companies to compare new drugs against the current “standard of
care” rather than placebo
raising
the evidence bar to demand trials that answer more relevant questions
useful for patients and physicians
dramatically
increasing the transparency of drug evaluation process, so that the
evidence supporting decisions can be evaluated
improving
the way we share information on the risks and benefits of drugs
The
most prescribed drugs of all are painkillers that typically are
highly addictive. Big Pharma with the help of their global army of
doctors have purposely and calculatingly turned a large percentage of
us especially in the United States into hardcore drug addicts, both
physically and psychologically addicted to artificial synthetic
substances that are detrimental to our health and well-being. More
than three
quarters of US citizens over 50 are
currently taking prescribed medication. One in four women in their
40’s and 50’s is taking antidepressants. Though the US contains
just 5% of the world population, it consumes over half of all
prescribed medication and a phenomenal 80%
of the world’s supply of painkillers.
Those who admit to taking prescription drugs on average take four
different prescription drugs daily.
And
the third reason our relationship with the pharmaceutical Industry
and how runs it itself matters is that large pharma conglomerates can
control product supply, product price and product demand. We have
recent evidence of ways in which price-fixing and market share have
been manipulated/divvied between the major players. Larger
companies also means less likelihood of smaller companies either
being competitive or perhaps taking risks with novel compounds. One
business strategy of larger companies is to focus on the
money-spinners.
Contrary
to popular belief, the pharmaceutical industry is not shy of
prevention. In fact, the NHS spends a small fortune on preventive
prescribing: cholesterol-lowing medications, heart slowing drugs and
the like. We do not expect people to lower their own cholesterol or
exercise their heart into a better shape. In my view, pharma has
actively encouraged modern man to take a pill rather than take
responsibility.
“The
2015 Harris corporate reputation poll is out and the news for Big
Pharma isn’t good, to say the least. In the poll—which
measures the “reputation quotient” of the most visible American
companies among the general public—Big Pharma ranked ninth out of
14 industries and was right in line with insurance companies and
airlines when it comes to respect”
Jacky Law –
“Outlining the
history of the pharmaceutical
industry,
Law identifies what she says is the failure of a regulatory framework
that assumes pharmaceutical companies always produce worthwhile
products that society will want.”
