Sunday, November 21, 2004

The big sting

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.

Further Reading

Marcia Angell, The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Angell is a former editor-in-chief of the New England Journal of Medicine.

Jerry Avorn, Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs. Avorn is a professor at the Harvard Medical School.

Jerome P. Kassirer, On the Take: How America's Complicity with Big Business Can Endanger Your Health. Kassirer is another former editor of the New England Journal of Medicine.

John Abramson, Overdosed America: The Broken Promise of American Medicine.

Student Activities

  1. Discuss.

Discuss this essay and more over on the Science Musings Blog.