Imagine millions of viewers around the world glued to their screens of choice for a MasterChef-style competition between medicines, where the winner receives a multi-million dollar prize for delivering the greatest health benefits. This intriguing idea and other issues relating to the marketing of medicines is discussed by health economist Professor Gavin Mooney who expands on Croakey’s piece last week about investigations into GlaxoSmithKline’s sales, marketing and pricing practices in the US which have resulted in the largest healthcare fraud settlement ($US 3 billion) in that country’s history. Gavin writes….
The pharmaceutical group GlaxoSmithKline has been fined $3bn after admitting to bribing doctors and encouraging the prescription of unsuitable antidepressants to children. Psychiatrists and their partners were flown to five-star hotels, on all-expenses-paid trips where speakers, paid up to $2,500 to attend, gave presentations on the drugs. They could enjoy diving, golf, fishing and other extra activities arranged by the company.
GSK also paid for articles on its drugs to appear in medical journals and “independent” doctors were hired by the company to promote the treatments, according to court documents. The lengths to which the pharmaceutical industry will go to pursue profits are quite extraordinary. It is also important to note that often their behaviour requires others to respond positively or even just naïvely to their overtures. This happens often. But every now and then Big Pharma manages to find yet more offensive ways of trying to corrupt research and clinicians. GSK has been caught out.
The industry pursues some extraordinary tactics to attain truly massive profits. As Angell writes, for 2002 the combined profits of the ten drug companies in the US on the ‘Fortune 500’ – the top US companies – ‘were more than the profits of all the other 490 businesses put together’. According to Angell, what goes into marketing is ‘two and a half time the expenditures on R & D’.
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What is most shocking about this latest situation with GSK is that while we cannot expect drug companies to behave otherwise, since their task is not to produce health but to produce profits, doctors and others remain willing to take the Big Pharma shilling without any recognition of the conflicts of interests involved.
I served for a couple of years on the Economics Sub-committee of the Pharmaceutical Benefits Advisory Committee and became aware then first hand how dependent such regulatory bodies are on the published research results in academic journals. The ghost writing of some of these results on behalf of industry is well known and occasionally they get found out. In essence because they lied or obfuscated or manipulated the results. The industry then gets punished (rather lightly given their massive profits). But what about those doctors, often ‘leaders’ in their fields who sign on as authors? Why do they not get punished? ‘Medical communication agencies’ are employed by the pharmaceutical industry to draft articles which are then passed on to doctors to put their names to for publication in scientific journals. Within health policy circlesthis practice has been known about for years but as we have just seen it still goes on.
An article in the British newspaper The Guardian quotes a medical writer who has worked for ‘medical communication agencies’ telling of how an article he wrote about a new cancer treatment would appear in print later ‘with an oncologist considered a “key opinion leader” listed as the author in his stead’. He is quoted as saying: ‘You’d do the same thing if you were selling cornflakes. It’s no different.’
Most of the research on drugs is paid for by the industry. Yet various studies have shown that industry funded research is more likely to show that a pharmaceutical product is effective in its treatment. The ‘best’ example is reported by Gupta and Cohen:
Researchers from the United States and Canada looked at 546 drug trials . . . 346 of them, or 63 per cent, were funded by the drug industry. The remaining 200 were paid for by government or non-profit organizations. Study authors found that more than 85 per cent of the industry-funded trials in their sample posted favorable outcomes and were 4 times more likely to report findings that favored their drug.
A few years ago I suggested to a very senior university administrator that the university should not accept drug company money when evaluating drugs, since there was good evidence that such funding resulted in bias in favour of the company’s drug. The university administrator’s response? ‘But if we say no, Gavin, the company will just go down the road to another university!’
What to do? One attractive option is proposed by economist Joseph Stiglitz. He suggested a massive multi-billion-dollar prize be set up by governments which would be awarded on the basis of drug inventions which did the most to improve health. I would argue that rather than have governments pay for the prize, as Stiglitz proposes, that this is funded by having a tax of say 100% on drug companies’ marketing budgets.
A recent case in Western Australia exemplifies some of the issues we need to confront. Pharmaceutical companies were paying for travel and accommodation for doctors to attend conferences overseas. When this arrangement was exposed, the state’s director general for health responded by saying that the companies involved had in each case signed an agreement that there was no obligation on the conference attendee to do anything to benefit the company. Such a justification is at best just naïve.The Big Pharma companies are not charitable organisations. They are profit-seeking. If the industry pays for someone to go to a conference in Paris or Los Angeles or wherever, they do so because they think it is in their shareholders’ interests. It is as simple as that.
Have we become so inured to the ways of Big Pharma that we just shrug our shoulders and move on? And have we come to accept that some medical colleagues will put their names to articles for reasons other than that they want to tell the world of the valid research they have done?
Time to change.