The Pharmaceutical Industry

Overview

Drug companies try to project a warm-and-fuzzy image, using corporate slogans like, “Life is our life's work”, and “We're part of the cure”.  The reality, though, is that pharmaceutical companies engage in cut-throat competition, questionable (or worse) business practices, and outright fraud.  You'd be hard-pressed to find a more-Machiavellian industry.

The Betty Dong story:  Scientific integrity vs. profits

Although it's true that drug companies spend billions of dollars on research, these companies are not primarily in the science business – they're in the business business.  All too often, if the science doesn't support a company's marketing claims, so much the worse for science.

The story of Betty Dong illustrates what can happen when the fox guards the henhouse.  Dr. Betty Dong is a clinical pharmacy professor at the University of California, San Francisco.  In 1987, she received a research grant from the Boots Pharmaceuticals Company for a study on Synthroid, a thyroid medication.  When her results turned out to be unfavorable toward the sponsor, Boots Pharma waged a vicious, years-long smear campaign against Dr. Dong.  The company made public allegations against Dr. Dong, questioning her competence and her ethics.  (None of the accusations were ever corroborated by independent parties.)

The preceding short overview doesn't really do justice to this story.  To get the full flavor of this sordid affair, see this more-comprehensive account written by neuroscientist Elliot Valenstein.

Other incidents of harassment

  • In case similar to that of Dr. Dong, researcher Nancy Olivieri was also the victim of slander and intimidation.  Olivieri's “crime” was her desire to release information showing that children were being harmed by an experimental drug made by Apotex (a Canadian pharmaceutical company).  During a 60 Minutes interview, the head of Apotex said that Olivieri was “nuts”.  In another incident, colleagues who supported Olivieri were referred to as a “group of pigs”.  She was eventually vindicated, but only after a protracted, expensive struggle.

  • David Healy is a British psychiatrist who studies antidepressants.  The powers-that-be were not pleased when Dr. Healy delivered a lecture questioning the safety of Eli Lilly's drug Prozac.  Dr. Healy had originally been offered a job at the University of Toronto, but the offer was suddenly rescinded after his lecture.  The Eli Lilly Company was (and continues to be) a major source of funding at the school.  Many people believe that Lilly pressured the University of Toronto to dump Healy.

Sales ahead of safety

Pharmaceutical companies will fight tooth and nail to protect their interests, even when patient lives may be endangered.  The Olivieri case described above is one example of such aggressive tactics.  Some additional examples are listed below:

  • Fenoterol is a bronchodilator drug that can be used to treat asthma.  When epidemiologists in New Zealand discovered that fenoterol is associated with cardiovascular-related deaths, the manufacturer – the Boehringer Ingelheim Company – did everything possible to suppress the results of the study.  Nevertheless, the researchers eventually overcame Boehringer Ingelheim's underhanded tactics, and the New Zealand authorities subsequently withdrew fenoterol from the market.  The details are available here.

  • The case of Rezulin is even more egregious.  Rezulin is a diabetes drug that had been developed and marketed by the Warner-Lambert Company (now a part of Pfizer).  In March of 2000, the FDA ordered Rezulin to be withdrawn from the market.  The drug was causing instances of severe liver damage, sometimes leading to death.  Subsequent investigation revealed that Warner-Lambert had long known about Rezulin's problems with liver toxicity.  In fact, the company had lied to the FDA when Rezulin was being considered for approval back in 1996.  Now, as a result of lawsuits, company officials are being forced to ’fess-up, and they're using Clintonesque dissembling:

    “  ‘Comparable’ is, is, you know, is an interesting word”, Whitcomb testified.  “Is 2.2 percent different than 0.6 percent? ... I think you could look at 2.2 and 0.6 and say that those are similar numbers, you know, when you look at this now.  I mean, ‘similar’ is a — is a very broad term... . I don't think that these numbers are, are all that different.”

  • Drug companies place convenience ahead of safety when deciding on recommended dosages.  When a new drug is approved, the drug company will typically aim for a high suggested starting dose in order to maximize both effects and profits.  However, for many patients, the resulting dose is much too high and can cause problems.  Dr. Jay S. Cohen is a professor of medicine and psychiatry at the University of California at San Diego.  He has written an exposé of pharmaceutical dosing practices.  Cohen's book is called, Over Dose:  The Case Against the Drug Companies.  More recently, researchers at Georgetown University confirmed Cohen's findings.

Concern grows among physicians

Even the medical establishment is becoming increasingly uncomfortable with the behavior of pharmaceutical companies.

  • In May of 2000, Marcia Angell – who was then the editor-in-chief of the New England Journal of Medicine – wrote a surprisingly candid editorial titled, “Is Academic Medicine for Sale?”  Angell referred to the “Faustian bargain” that takes place when scientists accept pharmaceutical money.

  • In a more-recent article, psychiatrist and researcher E. Fuller Torrey expressed outrage at the aggressive marketing tactics used by drug companies in promoting their psychotropic medications:  “The Going Rate on Shrinks:  Big Pharma and the buying of psychiatry”

  • A group of healthcare providers have formed an organization called, “No Free Lunch”.  This organization aims to counter the relentless promotional efforts of drug companies.

  • Dr. Loren Mosher is a Harvard-trained psychiatrist and the former head of the National Institutes of Mental Health (NIMH) Center for Studies of Schizophrenia.  In 1998, Dr. Mosher publicly resigned from the American Psychiatric Association (APA), partly to protest the increasing ties between the APA and drug companies.  Additional information about Dr. Mosher is available at his website:  www.moshersoteria.com.

Pharmaceutical funding leads to biased research

It's not hard to imagine that scientists might be unduly influenced (perhaps unconsciously) by the groups providing research funds.  But is this influence just theoretical, or is it real?  It turns out that the bias isn't hypothetical – it's been quantified and documented in a study published by the New England Journal of Medicine.  Even the Wall Street Journal, which is not usually known for exposing ethical issues related to corporate behavior, published a story of the findings:  “Researchers have fiercely debated the risks and benefits of calcium channel blockers, a class of drugs that treat hypertension and angina.  Now, a new study shows that most of the scientists who have publicly supported the drugs over the past two years have undisclosed financial ties to the companies that make them.  The findings raise anew questions about the independence of doctors and researchers who accept drug-company funding, and the need to disclose such ties.”  More...

Pulitzer Prize awarded to pharmaceutical muckraker

David Willman, a writer for the Los Angeles Times, won the 2001 Pulitzer Prize for a series of investigative reports that unmasked problems with the FDA and with the pharmaceutical industry.  Rather than re-state Willman's findings, I'll just include a link to an archive of his award-winning articles.  The reports add up to a fair amount of reading, but they provide a detailed, well-documented look at serious ethical lapses associated with the regulation and sale of prescription drugs.

Other items related to the pharmaceutical industry:

  • Healthy Skepticism is an outstanding resource for getting the straight dope about misleading drug promotion.

  • No Free Lunch is another great site that exposes the truth about pharmaceutical companies and their marketing practices.

  • Dr. Michael Lascelles (of Sydney, Australia) writes an excellent blog about the pharmaceutical industry.  The blog is called, “Pharma Watch”.  Dr. Lascelles describes the blog as, “A monitor of pharmaceutical promotion – and the truth behind the hype.”

  • Pharmaceutical-industry news at Google News

  • Pharmaceuticals at the Washington Post website

  • Pharmaceuticals at Yahoo

  • Pharmaceutical facts and fallacies.

  • This whole page is about conflicts of interest in biomedical research.