For us, the most shocking thing in Melody Petersen’s book Our Daily Meds was her description of a special voicemail system Parke-Davis (a division of Warner Lambert) set up for Neurontin, the epilepsy drug the company illegally marketed for just about anything above the neck in the late 1990s. Petersen, a former pharmaceutical reporter for the New York Times, recounted how executives encouraged Neurontin marketers to communicate only through the voicemail network, rather than through more traceable means, like emails. Many know the ending: former sales rep David Franklin still had enough to blow the whistle, and the company paid $430 million on federal charges of off-label marketing.
It’s just one of the many disturbing stories in Our Daily Meds, which tells how in recent decades, the marketing arm of the U.S. pharmaceutical industry has morphed into something of a hydra, mythic in scale and impervious to data that show fewer and fewer new drugs are making us better, and some are even making us sick.
Petersen, whose book has received great reviews and raised eyebrows about industry practices (www.ourdailymedsthebook.com), spoke with PostScript about why she wrote it, and how she believes proposed legislation may alter this story’s next chapter.
P.S: Was there one thing you learned or story you reported on that made you decide you should write this book?
M.P: There wasn’t one thing. Instead, I decided to write my book as I learned how extensive the industry’s promotional efforts were. For some stories, I couldn’t find a medical expert who was not on the industry’s payroll. I learned that some of the articles I was reading in medical journals had been ghostwritten by Madison Avenue ad agencies hired by the drug companies. I listened to an executive give a speech on how he and his company had created a disease.
It’s really the scope of the industry’s marketing operations that is frightening. That is what I wanted the public to understand.
P.S: In your chapter ‘Midwestern Medicine Show,’ you introduce the idea of tech transfer as one way industry got closer to academia in recent decades. Your book makes clear that there were many external factors that have led to the coziness between industry and academic medicine today, but in your mind is there one that stands out?
M.P: For decades, we counted on academic researchers to help protect us from dangerous medicines and fraudulent science. There was once a clear division between academia and industry.
But in 1980, two things changed. First, the federal law known as Bayh-Dole Act was passed. It allowed academics working on federal grants to patent and profit from their discoveries. Then, that same year, the Supreme Court allowed the first patent to be placed on a living organism. This opened the door to the patenting of genes, cell lines, tissues and organs. It was then that universities began to see their laboratories as profit centers and their professors at entrepreneurs. Most of our brightest academic minds became consultants to industry.
Today, there are very few medical researchers left who are independent from industry. There are few scientists willing to raise questions about the enormous amount of questionable practices that are going on in medical science today. It’s a tragedy that has had stunning consequences on society.
P.S: The recent probe by Sen. Grassley – your hometown senator – of the industry payments to 3 Harvard child psychiatrists illuminated some problems in the honor-system disclosure system many academic medical centers rely on. And you also discussed the management plans that often come with them. How do you see disclosure – is it part of the solutions to industry’s influence on physicians, or not?
M.P: Public disclosure of the dollar amount of consulting and other fees each academic receives from the drug industry will help. But it won’t solve the problem. I think that academics working on federal grants should be banned from accepting any industrial money. We desperately need more scientists who put the lives of patients before the interests of industry.
P.S: Speaking of Sen. Grassley, do you see him as Sen. Kefauver’s heir to pharmaceutical inquiry? And do you think it will take another tragedy like Thalidomide, or Vioxx to cement something like the Sunshine act, or do you think the Congress is more receptive to legislation than it was during the Kefauver hearings?
M.P: The public should thank Senator Grassley for all he has been able to uncover in his investigations of the drug industry. In recent years, no one else in Congress has done more to try to stop the industry’s egregious promotional practices than he has.
I think the Sunshine act – the legislation to disclose industry payments – will pass. Some drug companies have already agreed to a watered-down version of the bill. In Washington, proposed legislation has an unfortunate way of being weakened until it does little of what we thought it would do.
P.S: What does the thalidomide tragedy in the late 1950s and the drug’s reappearance on the market as ‘Thalomid’ for multiple myeloma today say for the importance of institutional memory? Whose job was it not to forget, the FDA? The media? The public?
M.P: In the 1950s, pharmaceutical companies caused a tragedy for tens of thousands of families by aggressively selling thalidomide to pregnant women even though there was no science that said this was safe. But now, if careful scientific studies show that thalidomide can help patients with multiple myeloma and those patients are informed of all the risks, I think it is wonderful that it is available to those patients.
This gets to a bottomline point in my book: It’s not the medicines that are the problem. Medicines can help you if you get the right one at the right time. The problem is the aggressive marketing of medicines. The industry’s relentless promotion is leading doctors to prescribe medicines in ways that go beyond what is safe.
P.S: Even though their costs are rising exponentially, pharmaceuticals are still a relatively small slice of the health care cost pie. Where do you think pharmaceutical marketing falls in the bigger health care conversation going on in the U.S. today?
M.P: The only reason that prescription drugs are relatively small part of health costs is that we pay our physicians and our hospitals so much money. Doctors make astonishing salaries in the U.S. compared to what they might make in other countries.
But even then, prescription drugs are eating up a larger slice of total health costs every year because of the drug industry’s non-stop promotion and steep price increases. In 1980, we spent $12 billion on prescription drugs. In 2005, we spent more than $250 billion.
And the same marketing techniques used to boost sales of medicines are now being used to sell medical devices, diagnostic tests, hospital procedures and physician services. American medicine today is driven by marketing.
The consequences of this go beyond the overwhelming financial cost. The aggressive promotion has made the system dangerous. Every year, there are thousands of needless deaths because of overtreatment.
P.S: With NEJM reporting that nearly 94 percent of physicians have some relationship with a drug company, and regulatory entrenchments like PDUFA, do you think there is political will to turn this around, and if so, from what corner will it come?
M.P: It needs to come from patients. Americans need to start a revolution. People need to stand up and say they’ve had enough. They need to demand that the nation’s medical system put patients before profit.
P.S: Our Daily Meds is a book that provides an I-can’t-believe on nearly every page. And to write it means you’ve seen a lot, and talked to a lot of people. Was there one discovery you made that most shocked you?
M.P: I’ve learned so many frightening things. It’s impossible to rank them. And that’s why I decided to write my book. A series of newspaper articles can’t describe the incredible power the pharmaceutical industry now has in American medicine. It has come to the point where the drug companies decide how patients will be treated and doctors just follow along.