Big Pharma Really Makes Me Feel Sick

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Big Pharma really makes me feel sick

Ian Bell on the drug industry

 

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FOR CLARITY'S sake, remind yourself that nobody at GlaxoSmithKline,

Britain's biggest pharmaceutical company (2006 revenues: $42.8 billion; income

$10.135bn), is to face prosecution. The company insists that it did nothing

wrong with regard to the anti-depressant drug Seroxat.

 

The Medical and Healthcare Regulatory Agency believes, on the other hand, that

the company withheld the full results of trials, particularly those suggesting

that the medication could increase the chances of suicide among teenagers. The

government is content, however, to " tighten " rules on information disclosure as

they affect an industry that ranks, after oil, as Britain's second biggest

export earner.

 

Ministers may yet be equally resolute in their treatment of Reckitt Benckiser,

makers of Gaviscon, the heartburn treatment. In this case it is alleged - and

denied - that the firm's executives " schemed " to block rival manufacturers from

marketing generic copies after the patent had lapsed. The company describes

itself as " a responsible firm which behaved honestly and ethically " . Its critics

say that it cheated the NHS out of perhaps £40 million.

 

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That is, simultaneously, a lot of money and a trivial sum, at least within the

strange universe of health spending. Some £90.7bn is earmarked for the NHS in

2007/2008, up from £34.6bn in 1998. Already, most of the extra has gone on

wages, 52% of it in 2005/2006. But in that same period at least 17% of extra

funding has gone on what the NHS Confederation defines as " extra drug costs "

compared with a mere 7% on capital costs.

 

But why not? Drugs save lives. The pharmaceutical industry spends billions on

research and development to spare us from sickness. We are the healthiest,

longest-lived, best-tended generation humanity has produced. Big Pharma surely

deserves credit.

That depends on who you believe. According to the anarcho-syndicalists at

PriceWaterhouseCoopers, the global pharmaceutical market is expected to double

by 2020 to $1.3 trillion. This market will depend, as it has for a quarter of a

century, on the often-extraordinary prices achieved for pills and potions. But

as the industry never fails to say, remarkable profits are required to justify

the huge costs of research. Humanity pays, but humanity benefits.

 

Up to a point. Take Pfizer, biggest, by most estimates, of the big. In 2006

its " healthcare revenues " stood at $48.3bn. It spent $7.59bn on R & D. Despite

that effort, Pfizer managed to finish the year with a net income of $19.33bn. As

a proportion of sales, that figure tends to make most FTSE and Fortune 500

companies gape. In 2003, in the US, the profits of the top 10 drugs companies,

US and European, fell to 14.3% of sales. The Fortune median was 4.6%.

 

The allegation is simple: profiteering. Add to that the claim that the

pharmaceutical industry is " disease-mongering " , promoting minor conditions to

the status of illnesses requiring drugs. Add again the fact that " marketing "

expenditure - $67bn in the US in 2002 - is generally two-and-a-half times the

amount spent on R & D.

 

Add further the claim that " innovation " within the industry is trivial, that

truly new drugs are few and far between, and often originate in academia and the

public sector. Add finally the charge that this is an industry with no sincere

interest in producing medicines for those in the third world who need them most.

According to Oxfam, the richest 15% of the world population puts away in excess

of 90% of its pharmaceuticals. The drugs trade, having fought a long (though

unsuccessful) battle to deny the HIV victims of South Africa cheap retrovirals,

is still failing to put its famous R & D effort at the service of billions.

Between 1999 and 2004, according to the charity, 163 medicines were " brought

to market " . Only three were new drugs aimed at the diseases afflicting the third

world. TB is now killing two million people a year. Sufferers require six months

of treatment. But according to Helena Vines-Fiestas, author of an Oxfam report,

" the most recent medicine is 30 years old " .

 

According to the Commons public accounts committee, Big Pharma spends £850m a

year " marketing " products to GPs. This revelation followed a National Audit

Office survey showing that one in five of GPs is " more influenced " by drug reps

than by official advisers. Influenced in what sense? To keep pace with the very

latest in medical advances? To study the favourable (but not the less

favourable) data that the drug firms supply? To attend conferences funded by the

pharmaceutical industry? To heed the fellow professionals employed - for their

expertise, surely, and not for their endorsement - by Big Pharma, the people who

sometimes also manage to serve on regulatory bodies? Or just to take receipt of

free samples?

 

Prefer, for now, to concentrate on all those dedicated GPs who just want to

know about breakthroughs. Marcia Angell, a lecturer in social medicine at

Harvard and an industry critic, has alleged there are far fewer of these than

the R & D propaganda would have us believe.

Angell recorded that between 1998 and 2003, 487 drugs were approved by the US

Food and Drug Administration. Of these, 78% were classified as " similar " to

drugs already on the market; 68% were not new compounds; and only 14% were

" likely to be improvements over older drugs " . Hence the huge marketing effort

devoted to mere " me-too " medicines. As Angell noted, " a uniquely important drug

would require very little promotion " . The cure for cancer is still awaited, but

the me-toos get that precious patent protection.

 

They need it. Between 2000 and 2004, according to the European Commission, the

number of actually new drugs coming to market had dropped from 40 to 29 a year.

The stock markets also fret over " thinning pipelines " as multi-billion dollar

" blockbuster " drugs fall out of patent. So Big Pharma has turned increasingly to

" partnerships " with universities and the public sector. State aid, if you like.

 

They appear to believe they have no other choice. Angell recalls that in 2002

the FDA approved 78 drugs. Only 17 contained new active ingredients and only

seven of those were classified as improvements on older medicines. The rub? Of

" those seven, not one came from a major US drug company " .

 

Still, there's hope for Big Pharma. If they can't find new ways to cure us,

they can always invent new ways to make us ill. Journalist and author Ray

Moynihan will tell you that these days " marketing strategies have focused on

promoting illness, rather than simply promoting drugs " . " Female sexual

dysfunction " , " irritable bowel syndrome " , " adult attention deficit disorder " and

the rest have been discovered as serious ailments, the better to sell pills,

while the companies " work " with patients' groups, medical groups, politicians

and the media.

 

Such strategies make a nonsense of the NHS ethos. The economic power of the

industry makes a nonsense of democratic oversight. The damage done to medicine

itself by a parasitic trade that is, in essence, robbing the sick is close to

incalculable. And the drugs, increasingly, don't work, not as billed, any more.

 

GlaxoSmithKline probably isn't too concerned by British legislation. In

January, the European Commission staged raids at its offices, and the offices of

a clutch of other drugs firms. " Possible anti-competitive behaviour " to prevent

cheap generics from reaching the market is the allegation. Now who would dream

of doing such a thing to those who are ill and in desperate need? And which

democracies would allow it?

 

 

 

 

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