Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Peterson

The pharmaceutical industry is out of control. Soaring prices threaten to bankrupt us, both individually and as a society. A multibillion-dollar propaganda machine has saturated all of us – from children to the very old – with the message that the solution to each and every one of life’s woes can be found in the form of a pill. The pharmaceutical and medical professions have become thoroughly corrupted by drug company money. The drug companies routinely bury clinical trials with negative findings, and even the most conscientious physician cannot be trusted to give his patients reliable information, since the journals he relies on cannot be trusted. The United States is the only nation in the developed world which does not regulate drug prices. Those prices bear no relation to the costs of developing and producing the drugs, and drug companies enjoy profit margins several times that of the average Fortune 500 company. And despite the industry’s blather about discovering “life-saving medicines,” most of their resources are devoted to the development and marketing of “me-too” drugs, often of marginal effectiveness, often for conditions which are better treated with existing generic drugs, or lifestyle changes, or by not regarding them as problems at all.

Most of this ground has been covered before, in books such as The Truth About the Drug Companies by Marcia Angell, M.D.; Selling Sickness by Ray Moynihan and Alan Cassels; Overdo$ed America by John Abramson, M.D.; Worried Sick by Nortin M. Hadler, M.D.; and Overtreated by Shannon Brownlee. All well worth reading, but if you are going to read only one book on the subject, make it Our Daily Meds by Melody Peterson. In methodical, bone-chilling detail, the author details just how far the drug companies will go in pursuit of the almighty dollar.

Peterson recounts the testimony of David Jones, a former executive of Abbott Laboratories, who in 1990 described to the United States Senate Committee on Labor and Human Resources the tactics his former employer used to market a useless remedy to people suffering from a terrible disease. The disease was Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease, a malady which robs its victims of their ability to move or speak, and then kills them. The proposed “remedy” was Thyrotropin-Releasing Hormone, a drug manufactured by Abbott. Company executives proposed marketing the drug to ALS patients as a solution to “short-term revenue problems.” In-house analysis predicted that it would take patients and their physicians six months to figure out the drug wasn’t working. A price tag of $10,000.00 per patient was proposed. It was pointed out that recent advances had made it possible to produce the drug more cheaply, and someone proposed lowering the price to $2,000.00. A marketing executive sneered at the idea. He declared that the reduction in price wouldn’t be necessary, since people would “hold garage sales” to help neighbors dying of ALS.

Peterson devotes an entire chapter to the saga of David Franklin, an idealistic young academic scientist who accepted a sales position at Parke-Davis, a subsidiary of Warner-Lambert. Parke-Davis was the maker of the drug Neurontin, a drug originally developed for treatment of epilepsy, but which in clinical trials had shown such disappointing results that the FDA would approve its use only for patients who had not improved after trying another medication. Not satisfied with this, Parke-Davis executives formed what they called the New Product Committee, to promote prescribing Neurontin for a dizzying variety of conditions, including migraines, attention-deficit hyperactivity disorder, sexual dysfunction, manic depression, tremors, peripheral neuropathy, ALS…the list went on and on.

Federal regulations actually prohibit the drug companies from promoting drugs for any uses not approved by the FDA, but physicians have almost unlimited latitude in prescribing any medication they want. The goal of the New Product Committee was to make an end run around the rules, to promote off-label use of Neurontin under the guise of physician education. A senior executive for Parke-Davis harangued Franklin and other salespeople to push Neurontin to physicians as aggressively as possible. “That’s where we need to be, holding their hand and whispering ‘Neurontin for pain, Neurontin for monotherapy, Neurontin for bipolar, Neurontin for everything.”

Parke-Davis hosted dinners at fancy restaurants and “meetings” at luxury resorts to shill Neurontin. They tracked doctors’ prescribing habits and lavished gifts on the ones who wrote the most prescriptions for their product.

Such extravagant largesse created a monstrous sense of entitlement among the recipient doctors. No matter what Parke-Davis did for them, it never seemed to be enough. “Hotel too cold inside,” one doctor wrote in an evaluation he filled out after attending a meeting at the Sheraton Hotel in Atlantic City. “Resort places preferred.” He also complained that while Parke-Davis had paid for his wife and children to accompany him, they had not paid for entertainment for the tykes. Another doctor groused about the lack of a chauffeured car, after attending a meeting at the Helmsley Park Lane Hotel overlooking Central Park in Manhattan.

“I underwent a stunning revision of my beliefs about the medical profession,” Franklin would remark later. Once he had believed that a physician’s first duty was to his patients, and that no amount of money could change that. “You’d like to think this kind of simple scheme wouldn’t work with physicians,” he said. “It works remarkably well.”

Faced with mounting evidence that Neurontin was largely ineffective against seizures or any other medical condition, and haunted by reports of children harmed by the drug, Franklin took his concerns to his boss, who jeered, “The doctor shouldn’t have been using the stuff off-label anyway.”

Franklin eventually resigned and filed a whistle-blower lawsuit against Parke Davis. In the meantime, Warner-Lambert sold Parke-Davis to Pfizer, and in May 2004 Pfizer agreed to pay $430 million to settle claims that Parke-Davis had marketed Neurontin illegally. By that time Pfizer had earned $10 billion from sales of Neurontin, mostly from off-label prescriptions. No criminal charges were ever filed against anyone connected with the case.

The depredations of the pharmaceutical industry continue unabated. Peterson details the cost to society, not just in terms of dollars, but the human cost as well. The elderly are particularly vulnerable. Half of adults over the age of 65 take five or more prescription medicines or supplements each week. In this era of managed care, the family doctor has gone the way hand-cranked telephone, and nobody is responsible for caring for the patient as a whole person. As patients go from one specialist to another, layer upon layer of prescriptions build up, like coral on a reef. Nobody knows what the long-term combined effects of this cocktail of pills our elderly (and increasingly, our middle-aged and young people) are swallowing will be. This is a gigantic, uncontrolled experiment.

A study published in 1994 concluded that that legal over-the-counter and prescription drugs kill over 100,000 people a year. Only heart disease, cancer, and stroke kill more people.

Actually, that figure of 100,000 deaths a year was a lowball estimate, since it only included patients who died in hospitals, taking the recommended dosages. It did not include accidental or intentional overdoses, and it did not include people who died anywhere besides hospitals. It doesn’t include people who died in car crashes caused by drivers under the influence of prescription drugs (Peterson estimates that thousand of such accidents occur every year). Also, since spending on medicine has increased every year since that study was performed, it seems likely that the number of people dying from their medications has increased as well.

The total number of people who die every year from reactions to their medications is unknown, and nobody seems very interested in finding out. Peterson points out that in the years following World War II, 50% of patients who died in hospitals were autopsied. Today that figure is more like 8%. Fewer than one out of a hundred people who die in nursing homes are autopsied. What do you think the chances are that hospitals will heed Peterson’s call to resume the practice of autopsies on a large scale, to find out just what it is people in hospitals die of?

The toll in human suffering caused by the drug industry doesn’t end there. There’s the thousands of senior citizens every year who stumble under the influence of psychotropic medication and suffer hip fractures. And there’s people like Jerry Houk, a thirty-six year old former forklift operator profiled by Peterson. Houk suffered from Type II Diabetes, a condition which usually can be prevented or managed by exercising and eating sensibly. Instead, swayed by a “personal” letter from Parke-Davis, Houk took a new drug called Rezulin and ended up needing a liver transplant – turning him into a permanent source of revenue for the drug companies.

And where has all this relentless medicating gotten us? Adjusted for inflation, per capita spending on drugs went up seventeen times between 1980 and 2003. Not seventeen percent more – SEVENTEEN TIMES more. And yet, life expectancy at 65 has barely budged. Despite all the drugs we swallow, we still grow old and die. That hasn’t changed.

Today our nation’s rivers contain measurable amounts of Prozac – enough to stunt the growth of frogs who live in those waters. Why wasn’t this front-page headline news? Our society has devolved into a drug-obsessed dystopia that even Philip K. Dick couldn’t have imagined in his worst nightmares.