THE SEARCH FOR ETHICS IN MEDICINEHelke Ferrie April 1, 2004
When Increasing Shareholder Value Collides with the Public Good
On March 4 and 5, a conference at Sunnybrook Estates allowed me to peek into the world of Big Pharma. My media pass to the Canadian Forum on Pharmaceutical Marketing stated: “Hear how the world’s leading pharmaceutical companies are modernizing their global branding, internet marketing and competitive intelligence techniques to improve shareholder value.” Speakers came from Big Pharma giants Pfizer, AstraZeneca, Merck Frosst, Bayer, Wyeth, leading medical biotech firms, the Canadian Medical Association, and government. Presentations covered “strategies for the evolving global market,” trends in “biopharmaceuticals,” “competitive intelligence… for long-term gains,” “maximizing loyalty in patients,” and Direct To Customer Advertising (DTCA). Even a panel discussion was included on “marketing and ethics.”
Being accustomed to the high energy of medical conferences and political activism events, I wondered what people would be like who work for the world’s second largest industry (after armaments). Only 35 people attended, including the speakers, technicians and me (the only reporter). The mood was subdued. It quickly emerged from the power-point presentations’ pie-charts, graphs and statistics that the fever chart of world drug sales suggests an industry in poor health.
Martine Richard, of Canada’s Patent Medicine’s Pricing Review Board, reported that in 2002 pharmaceutical sales in the “major world markets” rang in at $638.8 billion US, obtained from sales in the U.S. (53.4%), Canada (2.6%), and Europe (19.1%) totaling 75.1% and representing about 600 million people (that is $1,060 US for every individual). The rest of the world, being a few billion poor people with malaria, TB, regular infections, and AIDS are not part of the “major” market. They can’t pay for patented drugs.
This drug habit is driven by shareholders’ interests, and this conference was devoted to them. So, presenters focused on obstacles to growth and how to generate more consumption (more sick people). The key-note speaker, Pierre Gaudrault, represented Pfizer. He identified obstacles to industry growth as: the limits of chemistry, governments frantic to reduce health costs, cheaper generic drugs, and popular pressure to change patent laws. As of 2004, only three new active substances have been submitted for patenting, as opposed to 10 in 1999, and 29 a couple of years earlier. Big Pharma calls that the “pipe-line problem” — no new potential blockbuster drugs in the works: synthetic chemistry is finite. The cost of research and development has simultaneously gone through the roof: in 1988 it cost $150 million US to bring a new drug to market, and now it’s about $1 billion US, and evidently, a few more billion are unlikely to produce a new blockbuster. His solution was to exhort everybody to “capture customer loyalty, enthusiasm, and commitment around the world.” He ended with an inspirational quote, known to all environmental activists, from the great Rene Dubois: “Act locally — think globally!”
In 2002 in North America alone more than 100,000 drug sales reps were working the doctors’ offices, a three-fold increase from 1993, or one rep per every five doctors. The return on investment for every U.S. dollar spent on promotion in 1996 was $3.34 US, but by 1999 it had decreased to $1.94 US. Marketing in 1996 cost $6.1 billion US, but only three years later Big Pharma was throwing $9.4 billion US at marketing and advertising (Sawaya, 2002).
So, dirty tricks increased: financing phony patient support groups (Toronto Star Feb. 7, 2004); inventing new diseases (Pfizer’s “social anxiety disorder,” supposedly treatable by Zoloft, was invented by Fred Nadjarian of Roche in Australia for which he faced a public disgracing); attempting to use Children’s Aid Society wards without their knowledge as human research subjects for antidepressants (Hamilton Spectator Dec. 11,2002); the widespread sale of doctors’ prescription patterns by pharmacies to Big Pharma in contravention of current privacy laws (see editorial in the March 2, 2004, Canadian Medical Medical Association Journal); and many more are told in the book Prescription Games. Almost every major drug is under legal challenge, annually costing hundreds of millions of dollars in out-of-court settlements or fines (from The Corporation documentary).
Much of the discussions at this conference focused on that magical solution to a troubled market: Direct to Consumer Advertising (DTCA). Various speakers described how it had increased sales by close to 70% annually in the U.S., and reading from a February 4th FDA memo, they noted that DTCA especially increases customer compliance! The compliance even lasts after side effects emerge, especially on lucrative antidepressants and cholesterol-lowering drugs. But the speakers cautioned, Canadian activists are astonishingly successful in blocking DTCA. Even though Canada has the ultimate “industry-friendly” Health Minister, Pierre Pettigrew, he told Big Pharma that there was no reason to introduce DTCA here because there was “just no evidence to show that this enormous increase in drug consumption in the U.S. had improved health overall.” When the question of ads for vaccines was raised, sighs of relief were heard and everyone was reminded to take heart as, thankfully, those are exempt from Canadian DTCA rules. Vaccines are the new frontier of corporate medicine.
Of course, there is a statistic, mentioning which in this meeting would have been equivalent to farting at a royal reception: The world’s most prestigious medical school, Johns Hopkins in Baltimore, published last year numbers indicating that drugs and doctors’ mistakes may be the primary leading cause of death in the U.S., costing the economy $80 billion US annually. (Details at www.mercola.com; all research on www.garynull.com).
Dr. Andre de Villiers was different. He reported on his medical biotech company that markets the technology and chemicals used to treat certain cancers and surgical transplants. This technology identifies cancer cells for targeted destruction while leaving healthy cells intact. Similarly, donor rejection can frequently be solved, without killing the patient’s entire immune system with immuno-suppressant drugs, by zeroing in on only those immune factors that are causing the rejection: high tech medicine that works for life. Having lost a daughter in 1986 to a disease this technology now routinely cures, I was deeply impressed. He pointed out, understandably smugly, that his was “good marketing because it’s a good product and good science.” Good point.
Considering that the American Journal of Cardiology last August published findings indicating that heart disease and cholesterol may have no link at all, a finding supported by European research, the blockbuster drug Lipidor may soon prove that even blockbusters aren’t what they used to be as their supportive science winds up to be neither.
“ETHICS” — WHAT’S THAT?
The ethics panel at this conference revealed just how unethical the medical profession has become. McGill University’s ethics expert Dr. Eugene Bereza and University of Toronto’s Dr. Michael Gordon were charming, eloquent, blunt and devastatingly truthful. Supporting the recent editorial in the CMAJ (Feb. 17, March 2) they agreed that current wholesale bullying of researchers (allowed to publish only drug-supporting results) and doctors (bribed and coerced into prescribing new drugs) is unacceptable. Citing the Nancy Olivieri case (see my March article in Vitality), Dr. Gordon observed, “Just how bad does this have to become!”
While conceding that many drugs are indispensable, they observed that research dollars today come virtually only from Big Pharma, and that this relationship does not promote excellence. Pharmaceutical shareholders need more and more sick people in order to turn a profit, while scientists want to cure sick people. Some serious efforts are being made to stop this abuse: McMaster Medical School teaches its students Ten Commandments for handling drug reps. The first being: “Physicians should maintain control” of the encounter. The rest focus on demanding scientific proof for every claim made, and the last insists the doctor may not “commit to the use of the product,” but merely indicate that “it will be given further consideration.” The ethicists also suggested that Big Pharma should consider self-restraint with all its coercive dirty tricks. What a concept!
When the discussion was opened for questions from the floor, not even one was posed. Nobody appeared to wonder why everybody is so ticked off, what might possibly be wrong with the products, prices or drug effectiveness, and what alternate marketing strategy should be considered. Imagine Mercedes, BMW, or Volvo being told their cars are dangerous to drive and that people are mad about their engineers lying and cheating about the physics involved in their manufacture, resulting in many drivers being crippled or killed. Since those cars are synonymous with excellence, this is unthinkable.
A SHORT SURVIVAL GUIDE FOR DEALING WITH DRUGS
As the ethics panel pointed out, U.S. judges ruling on Big Pharma cases agree that this industry is the cause for the corruption of medical science, education and practice. So, whom do you trust and what can you believe? The simple rule of thumb is: look who paid for the study. But if sleuthing through journals is impossible when you have to make a quick decision, having just been handed a prescription, here are some suggestions on how to navigate the minefield of pharmacology:
1. Always consult the Compendium of Pharmaceuticals and Specialties. The CPS is the annually updated compendium of all Health Canada-approved drugs sent to every pharmacy and doctor; it contains the chemistry, cautions, and dosages the manufacturer must by law provide — always ask your doctor or pharmacist to explain these in ordinary language. Refusal is a contravention of the Canada Health Act which requires informed consent.
2. Avoid taking a drug that is listed as potentially “hepatoxic” (toxic to the liver) and requires regular liver function tests. Remember, the majority of liver transplants are done because the liver was killed by a drug — not a disease.
3. Avoid drugs that interfere with any “cytochrome” (portion of a cancer-protective gene), even if just “in combination with” some other drug. Messing with genes is a shot in the dark that neither doctor or manufacturer understands — what happens is usually irreversible.
4. Anything that reduces “dopamine,” or any other neurotransmitter’s function, generally causes irreversible neurological harm, such as tardive dyskinesia.
5. A drug that lowers immune function (T-cell or B-cell production or activity), such as cortisone-based substances, chemotherapy drugs, and antibiotics have serious lasting effects. Research this on the Internet or in the library and look for alternatives. If unavoidable, you can limit negative effects and enhance the drug’s intended effectiveness by taking supportive nutrients in high, therapeutic doses. Negative interactions are mostly myths. Example: you supposedly can’t take pro-biotics, such as acidophilus, with antibiotics; in fact, taking them prevents candida overgrowth. For known interactions consult the annually updated “Natural Medicines: Comprehensive Database,” also on www.NaturalDatabase.com
6. If “long-term effects are unknown” — check the Internet and find out more. This is a vitally important warning. Sometimes, such a drug may be helpful and unavoidable for a short period, but taken for more than a month may be bad news. Read the books below to find out how and why.
7. Anything that cautions use in lactating or pregnant women indicates a systemic effect (crossing the placenta and blood-brain barrier). Such drugs are potentially teratogenic (causing birth defects): they can cause irreversible damage before birth, or organ damage later.
8. Drug manufacturers are not obliged to inform about nutrient depletions caused by all (!) synthetic drugs, so the CPS is no help. Check the compendium by pharmacists Pelten and LaValle listed below; if the drug is a must, protect your body by taking those nutrients it depletes. Example: all synthetic “blood thinners” and lipid-lowering drugs require potassium, magnesium and Co-enzyme Q10 to avoid increasing the risk of heart failure.
9. Information must come from somebody other than the manufacturer, Health Canada, or patient groups funded by drug companies. Send the group (especially those working for lucrative illnesses such as asthma, cancer, diabetes, multiple sclerosis etc.) an e-mail and ask who funds them.
10. Three areas that require your total attention are hormones (e.g. menopause therapy for women, cortisone for asthma etc.), cardiovascular disease, and depression. Cholesterol (or lipid) lowering drugs, anti-depressants, and synthetic (as opposed to natural!) hormones are harmful — in the highly informed opinion of mainstream medical researchers (see PharmaWatch (604) 687-6613, www.drugintel.com/drugs/statins and list below).
11. Always look for the generic brand (cheaper) or for older versions of the same drug (which are less toxic). The best source for alternatives to drugs is The Textbook of Nutritional Medicine (look for most recent edition from Third Line Press) and “orthomolecular medicine” (www.orthomed.org).
12. The World Health Organization lists only some 350 drugs as “essential.” None are still patent-protected, and they constitute only 5% of Big Pharma’s offerings; the remaining 95% is therefore suspect and demands your most careful critical scrutiny (visit the international leader in exposing Big Pharma’s product misinformation, Dr. Peter Mansfield, at www.mja.com.au).
The above article was abbreviated from Helke Ferrie’s book Hippocrates in the Land of Oz; A Survival Guide for our Golden Age of Medicine, Kos, April 2004. Orders: www.kospublishing.com
• www.cbc.ca/news for Health Canada’s 162,000 plus adverse reactions from 4,621 frequently used drugs; obtained by the CBC through legal action under Freedom of Information legislationwww.canadiancoalitionforhealthfreedom.ca
• Dr. James Lunney, MP – Ottawa office: (613) 992-5243 or firstname.lastname@example.org (support his bill to stop nutritional supplements from becoming prescription-only)
• www.medicare.ca (Canadian Health Coalition)
• J. Bakan, The Corporation: The Pathological Pursuit of Profit and Power, Viking, 2004 (the book on which the documentary is based)
• J. Robinson, Prescription Games, McClelland & Stewart, 2001 (available through www.amazon.ca)
• For full info on psychiatric drugs, get the consent form International Journal of Risk & Safety in Medicine, Jan. 1998 available from its author David.Cohen@umontreal.ca
• www.garynull.com most comprehensive source on mainstream science on vitamins, minerals, etc; alphabetically organized. Next time your doctor states: “There is no scientific evidence on vitamin C…” download that section. On this site also: “Death By Medicine” by Dr. Carolyn Dean who assembled the scientific evidence on the death toll caused by drugs and unnecessary surgery
• Dr. J.S. Cohen, Overdose: The Case Against the Drug Companies: Prescription Dugs, Side Effects and Your Health, Tarcher/Putnam, 2001
• Dr. D. Healy, Let Them Eat Prozac, Lorimer, 2003
• R. Pelton & J. VaValle, The Nutritional Cost of Prescription Drugs, Morton, 2000
• Dr. F. Ravikovich, The Plot Against Asthma and Allergy Patients, Kos, 2003
• Dr. A. Saul, Doctor Yourself: Natural Healing That Works, Basic Health Publications, 2003