Medicine, Mental Health & Big Pharma
Item
- Title
- Medicine, Mental Health & Big Pharma
- Creator
- Mira Shiva
- Date
- 2015
- extracted text
-
Medicine, Mental Health & Big Pharma
- Dr. Mira Shiva
The causes for the growth of Mental Health problems are several and are
complex. Many of them have their origin in the rapid transition in society, the
world around as a consequence of many neoliberal policies which have created
inequities, fragmentation, insecurity, mistrust, a sense of alienation loneliness,
increasing stress, competitiveness, unmet high aspirations, discontent, anger,
frustration, unfair demands on self, unrealistic deadlines, sleep depletion, erratic
eating
habits
of
unhealthy
processed
food,
sense
of
lack
of support,
meaninglessness in life, increasing materialism, consumerism, nuclearization of
family, eroding support systems, fickleness of relationships creates emotional
vacuum and sense of emptiness which is creating mental health problems like
depression, anxiety, stress. Increasing number of suicides even amongst the
young reflects something serious in our uncaring society that needs attention,
understanding, caring, compassion, contentment, kindness and healing.
Genetics, epigenetics, chemicals in food and environment, pesticides, processed
food loaded with monosodium glutamate (MSG), sugar saturated foods, colouring
agents, food additives, adverse effects of many pharmaceuticals and many other
things have contributed to neuro-behavioral changes. The increased distancing
from nature, missing out on fresh air, sunrise, sunsets, forests, fields, earth, birds,
and also from comforting hearth & home and their increasing replacement by a
virtual world or a harsher real world, causes restlessness, sense of emptiness and
demonstrates itself in the form of psychosomatic diseases.
The increase in Mental Health problems is definitely a significant public health
concern, a component of the growing Non Communicable diseases (NCDs) which
requires a comprehensive, integrated, holistic approach, where preventive,
promotive, curative and rehabilitative aspects are addressed, & the physical,
mental, social, spiritual, ecological political cultural dimensions duly considered.
1
The lack of holistically trained, experienced mental health care providers who are
gender sensitive, socially sensitive, rational and ethical is extremely unfortunate,
as it denies access to much needed care by millions. There is unfortunately non
access or poor access of Essential Medicines for Mental Health care when needed,
which are rationally prescribed & rationally consumed. With a mere 1.2% GDP as
the planned health budget with 80% out of pocket expenditure, unaffordability
of
medicines & tragically existing stigma associated with mental health
problems, needed care is further denied.
While this is reality for many, on the other hand the pharmaceutical industry is
managing to get life's natural conditions treated as medical problems requiring
medications. Loss of a loved one, bereavement on one hand and hyperactivity of
children on the other are being treated as mental health problems. When people
with problems are seen as a market to increase profits, expansion of the market
becomes a corporate strategy of the pharma companies. Whether it is sleep
problem because of high intake of caffeine, mental over stimulation related to
work, family, horror or crime films, video games, result is an increasing use of
sleeping pills, sedatives, tranquillizers even by those who just needed advice
about change in their life style when it is possible, rather than increasing use of
'dependence creating' medications, known to cause problems in the long run.
With the increase in the mental health problems as experienced by individuals
and their families, there is also a tremendous growth of the Medico Industrial
complex,
with
increase
in
medicalization,
commercialization
&
pharmaceuticalization of mental health care. There is an increase in the use,
overuse and misuse of medicines with aggressive marketing and promotion of
wide range of pharmaceutical products. There was a time when there was only
institutionalized mental health care available. When alternative approaches to
address mental health concerns started being used, promoted and socially
accepted, in the 1970's in the west, the pharmaceutical industry, along with the
promoters of biomedical paradigm, and the psychiatric associations decided to
promote use of medications for mental health problems. With the growth of the
medical industrial complex grew the production, promotion, prescription and
2
consumption of more and more medications for the mentally ill, as was also the
case with those with physical illness. To increase the medicine market, definitions
of what constituted mental illness were expanded.
Adverse effects of drugs
Even while admitting that in certain conditions medicines have a definite role,
they need to be prescribed rationally, in appropriate dosages, for appropriate
duration, appropriately withdrawn, the adverse drug reactions (ADRs) and drug
and drug interactions should be monitored, especially if other drugs are being
taken for other coexisting morbidities which are usually present in the elderly. It
requires that contraindications need to be excluded
before starting any
medications e.g., pregnancy, liver or kidney problem, etc., for certain drugs.
Special precautions need to be communicated, especially the possibilities of
adverse effects e.g., drug dependence and many other ADRs which are associated
with different categories of drugs. Serious adverse effects, even suicidal and
homicidal tendency have been reported with certain antidepressants, for which
Public Citizen Health had pressed for Black Box Warning. Over two decades ago,
the Week magazine carried Halcion antidepressant on its cover, reporting a case
of homicide by a patient on treatment with Halcion.
Adverse effects of prescribed drugs are the most common cause of
dementia and delirium in older people who were thought to have
"irreversible" Alzheimer's disease according to Dr. Eric Larson, M.D.,
M.P.H., F.A.C.P., Director Group Health Cooperative's Centre for Health
Studies & also Clinical Professor Medicine & Health, University of
Washington.
Worst Pills, Best Pills: A Consumer's Guide to Avoiding
Drug induced Death or
Illness, an excellent publication brought out by Dr. Sidney Wolfe and public
interest-minded doctors and Public Citizen, covers 'Mind Drugs' in Chapter 5 in
3
H SO
over 100 pages detailed information about medicines being used & misused for
problems of the mind. It also lists at least 10 pages of different medicines used for
various medical conditions which can cause depression, psychosis, hallucinations,
sudden onset of confusion or delirium or worsen dementia, & cause insomnia.
The list of drugs that can cause depression includes certain antibiotics, heart
related drugs, cholesterol drugs, high blood pressure drugs. There is a long list of
medications taken for other medical conditions which are known to cause
depression, dementia, insomnia as adverse effects. The need to take medicine
history & stopping these medications is needed if patient presents with these
problems, definitely not more drugs. Medications which should be avoided in the
elderly are not only being given but actively promoted by changing the Treatment
Guidelines. This is being done by ensuring that Pharmaceutical Company linked
experts are in the expert committees formulating the 'guidelines'.
Underplaying adverse effects in published literature is not just unethical but can
put patients at risk even by well-meaning doctors. Rational Use of Medicines
constitutes of using essential, effective, safe, and affordable medicines prescribed
with unbiased information and where persons with mental health problems are
concerned,
with
responsible
monitoring and follow
up. This
along with
psychotherapy, counseling, dietary, lifestyle advice is needed and not more and
more medication.
Drugs for Anxiety
Studies quoted in Chapter 5 on Mind Drugs in Public Citizen's Worst Pills, Best Pills
pg 168 showed that results of patients with anxiety receiving Benzodiazepines
tranquilizers medications & other group receiving a small dose of safer treatment
consisting solely of 'listening, explanation, advice & reassurance' were equally
effective in relieving anxiety, but those receiving the informal counseling were
more satisfied with their treatment than those receiving minor tranquilizers.
4
H
In another study patients with anxiety were given either one of the three
different tranquillizers or placebo (sugar pill). At the end of one month, based on
weekly evaluations by patients themselves & professional evaluators, results
showed all four treatments to be efficacious in their therapeutic effects on
relieving anxiety. Placebos worked as well as tranquillizers. There has been a
steady increase in use of medications such as sleeping pills, tranquillizers,
sedatives, mood elevators, antidepressants.
Worst Pills Best Pills states that in the US in 1985, psychotherapy alone or with
prescription drug was offered in 23% of the visits of patients with anxiety
disorders. By 1997, the use of psychotherapy had dropped precipitously to mere
5%. In 1985, antidepressants prescribed for anxiety disorders was only in 15.5%
visits of the patients. By 1997, antidepressant prescription increased to 40.4%.
Anti-depressants and Atypical Antipsychotics
According to Lisa Cosgrove and Harold J. Bursztajn, a meta-analysis of the efficacy
of anti depressants found that the magnitude of the benefit of anti depressant
medication, compared with placebo, increases with severity of depression
symptoms and may be minimal or non-existent on average in patients with mild
or moderate symptoms. Another research team conducting meta-analysis drew
the strong conclusion that the
relationship
between
initial
severity and
antidepressant efficacy is attributable to decreased responsiveness to placebo
among the very depressed patients rather than increased responsiveness to
medication. Assumption about superiority of atypical antipsychotics has been
questioned; no "differences in quality of life or effectiveness measures" between
typical and atypical classes of drugs was found. Because of the increasing
evidence of persistence of adverse effects such as sexual dysfunction or type 2
diabetes mellitus even after the medications have been discontinued, the atypical
antidepressants and antipsychotics are not advantageous for many patients.
5
It is difficult for people with serious mental illness because of fear of psychosis,
hopelessness and helplessness of severe depression to be able to weigh
treatment risks, benefits and alternatives. In the presence of often totally biased
information provided to doctors by the industry, where benefits are over
projected and risks are downplayed, the internalization of medication being safe,
effective and best follows in the minds of the medical care providers. This
increases the vulnerability of persons on treatment, as adverse events are not
monitored nor reported.
Ties with industry and Conflicts of interest
In the past years, concerns have been raised about the increasing pharma
companies' influence on the biased information published and disseminated
about benefits and risks of medications. These are done through corporate
sponsorship
of clinical trials, continuing medication
education, and
most
importantly, by influencing the diagnostic and treatment guidelines e.g.,
American Psychiatric Association's diagnostic and treatment guideline namely its
DSM and Clinical Practice Guidelines. DSM has enormous influence on clinical
practice in US and influences prescription guidelines elsewhere too. Cosgrove and
Bursztain note that the little attention given to adverse effects in DSM is obvious:
only two out of the 700 pages of text of the main body of DSM 4 dealt with
diagnosing
adverse
effects
of
psychotropic
drugs.
Neuroleptic
Malignant
Syndrome is just mentioned briefly, while adverse events like diabetes and other
metabolic conditions are not even mentioned in the ADR. Approximately 68% of
DSM 5 Task Force members reported having ties with the pharma industry (this
was 20% more than in previous DSM 4 task force members with ties with
industry). Industry sponsorship tends to be associated with pro industry
conclusions.
While randomized clinical trials are considered the gold standard for evaluating
efficacy and safety of medications, but by using inadequate methodological
design and outcome, use of sample sizes that are not clinically meaningful, failure
to report adverse effects, conducting short duration of trials 6-8 weeks which do
not permit serious assessment of long terms safety and efficacy, the clinical trials
and the results can be calculatedly compromised.
Conflicts of Interest need to be reported whether it is industry funded research,
or taking of honoraria for talks sponsored by the pharmaceutical companies
regarding their product. Presence of conflict of interest is known to exist in
regulatory bodies worldwide; in the advisory groups of even US Food and Drug
Administration 'FDA'. About half of the FDA's budget is derived from drug
company fees. USA Today's 2000 study of financial conflicts of 159 FDA Advisory
Committee meetings held
from Jan. 1998 to June 30, 2000 found 92% of the
meetings at least one member with Conflict of Interest, at 55% of the meetings
half or more FDA advisors had Conflict of Interest.
One example is of change in treatment of bereavement. Peter Whoriskey writes
in The Washington Post that previously the American Psychiatric Association
advised against diagnosing 'major depression' loss of loved one when the distress
is better accounted for by 'bereavement'. Such grief, experts, said was better left
to nature. American Medical Association in 2012 dropped the warning against
diagnosing depression in the bereaved, allowing it to be diagnosed with 'major
depression' to be treated with 'antidepressants'. Majority of the experts on the
committee (8 out of 11) who 'spearheaded' the changed 'New Diagnostic
Guideline' had either received research grants from drug companies, held stocks
in the companies or served the companies as speakers or as consultants. 6 out of
11 members reported financial ties during the time the committee met and 2
reported ties in the 5 years leading up to the committee assignment. A key
advisor of the committee who wrote the scientific justification for the change,
was ironically the lead author of the 2001 study on the antidepressant Wellbutrin
(Bupropion),
sponsored
by
GlaxoWellcome
showing
that
"Wellbutrin
antidepressant could be used to treat bereavement". The American Psychiatric
Association
appointed
"independent
review
panel
that
declared
that
recommendations given were free of bias". But most of the members of this
'oversight panel' had financial lies with the industry previously.
With normal grief after loss of a loved one being diagnosed as 'major depression'
requiring medication, this further increases the already $10 billion US anti
depressant market. It is evident that patient health could be compromised when
the 'Diagnostic and Treatment Guidelines' which widely influence prescription
writing by doctors, are largely written by 'industry hired experts' and issued by
medical societies that depend on pharmaceutical industry funding. Pro-industry
bias obviously compromises their ability to be objective.
Mosher, Gosden and Beder's chapter in Models of Madness elaborates that nearly
a third of American Psychiatric Association (APA) budget is derived from various
drug company sources (Psychiatric News 15.8.1997). APA meetings are dominated
by drug company sponsored exhibits and symposia. Variety of enticements like
food, drink, music, and lectures by industry paid experts are provided to symposia
attendees. In the US, drug companies have a large force of lobbyists in the Senate
to influence decisions. They also provide substantial support to mental health
advocacy groups like National Alliance of Mentally III (NAMI), National Mental
Health Association (NMHA), National Alliance for Research on Schizophrenia and
Affective Disorders (NARSAD), National Depressive Disorder Screening Day,
Anxiety Disorders Association, etc. (0. Harrow 2000).
'Detailers', 'Sales representatives' portrayed as 'conduits of information' are
industry's most successful marketing tool with direct personal contact with
doctors providing them 'well sanitized' information, promotional materials and
free samples of the company's products. Obviously, negative aspects like Adverse
Drug Reactions are underplayed. According to Marcia Angell, former Chief Editor
of New England Journal of Medicine & author of Science on Trial, these "conduits
of information" cost about $8 billion a year and the free samples given cost an
equivalent amount (Angell & Reiman 2001). The industry supports clinical trial
research at universities to the extent that it is doubtful that many departments of
8
psychiatry could survive without it. The pharmaceutical industry owns the data
from clinical trials it supports, decides which studies will be published, chooses
authors, ghost writes articles and revises them to present the best possible
interpretation of the data (Angell 2000).
Angell writes: "The ties between clinical researchers and industry include not only
grant support, but also a host of other financial arrangements. Researchers also
serve as consultants to companies, whose products they are studying, join
advisory boards, speakers bureaus, enter into patent and royalty arrangements,
agree to be listed authors of articles ghost written by interested companies,
promote drugs and devices at company sponsored symposiums and allow
themselves to be plied with expensive gifts and trips to luxurious settings. Many
also have equity interest in the companies." (Marcia Angell 2000. 'Is Academic
Medicine for Sale?' New England Journal of Medicine')
Marketing masquerading as education at professional meetings: Many
big professional meetings resemble bazaars dominated by garish drug
company exhibits and friendly sales people eager to ply doctors with
gifts, while they pitch their companies' drugs.
Instead
of sober
professionalism the atmosphere of these meetings is now 'trade show
hucksterism.'
A reporter from Boston Globe described her encounter with one
psychiatrist
at
the
annual
meeting
of the
American
Psychiatric
Association (APA): As a reward for attending the APA's annual meeting
the psychiatrist had received a small egg shaped clock from makers of
antidepressant Prozac; sleek thermos from Paxil, also an antidepressant;
and an engraved silver business card holder courtesy of Depakote, an
anticonvulsant (often prescribed for off-label use for a variety of
psychiatrist disorders). She got a neat CD carrying case from Risperdol,
an anti-psychotic. Her fare, and that of 30 others to the US from her
country, had been paid for by Pfizer.
Marcia Angell 2005 The Truth About the Drug Companies: How They
Deceive Us and What To Do About It pg 145-146.
In the words of Joanna Moncrieff and Phil Thomas, "The influence of the
pharmaceutical industry is particularly pernicious where the possibilities for
colonizing ever more aspects of human life are potentially limitless. [...] The
financial muscle of the pharmaceutical industry has helped to tip the scales in
favour of a predominantly biological view of psychiatric disorders. This has
submerged alternative therapeutic approaches, despite the fact that user led
research indicates that service users find a wide variety of non medical
approaches valuable in coping with emotional distress." If this is the situation in
one of the supposedly better regulated pharmaceutical markets, it is scary to
imagine what must be happening in other countries, where non access to
essential medicines, and to unbiased information occurs along with overuse,
irrational use and misuse of many of these Drugs, where Post Marketing
Surveillance, Drug Utilization Studies, Rational Use of Drugs rarely take place.
•
Big Pharma (the Multinational Pharmaceutical World) as it is known,
offered everything, the hopes and dreams we have of it; its vast, partly
realized potential for good; and its pitch dark underside, sustained by
huge wealth, pathological secrecy, corruption and greed.
•
Big Pharma is also engaged in the deliberate seduction of the Medical
Profession country by country, worldwide. It is spending a fortune on
influencing, hiring and purchasing academic judgement, to a point
where, in a few years' time, if Big Pharma continues unchecked on its
present happy path, un-bought medical opinion will be hard to find.
•
When giant pharmaceutical companies donate whole biotech
buildings and endorse professorships at Universities and teaching
hospitals, where products are tested, and developed, effect on the
supposedly impartial academic medical research could not be non
existent.
•
A matter of deep concern is the increasing alarming reports where
inconvenient scientific findings have been suppressed or rewritten and
those responsible for them hounded off their campuses with their
professional and personal reputations systematically trashed by
machinations of public relations agencies in the pay of the pharma.
John le Carre 2001, Essay 'In Place of Nations' in magazine The Nation
KS ll
Drug approval for the market
Mosher, Gosdnen and Beder's chapter notes that the tactics used by Big Pharma
to capture and expand its market for profits are several. Getting approval of the
drug for the market is the first step. To get approval for a new drug, studies are
needed to show that the drug is better than the placebo (not necessarily the
existing drug that is already being used) and that the drug does not have serious
side effects. These studies have to be conducted and the results provided to FDA.
Negative results and data from 'failed' studies which show no significant
difference from placebo are not supplied to the FDA, to ensure quick approval.
Approval is obtained for a certain selective Serotonin Reuptake Inhibitor (SSRI) for
a specific condition, e.g., for depression. Later approvals are obtained for other
conditions such as Obsessive Compulsive disorder (OCD), Post Traumatic Stress
Disorder (PTSD), and various anxiety disorders. With new studies and new
analyses of old studies, 'indications' for the drug can be extended to many new
conditions or on
new populations not covered earlier, e.g., the elderly, or the
youth.
Once the drug is in the market, doctors who receive 'perks' from drug companies
for talks, get a briefing by the company's sales representatives and can easily
prescribe it for "Off label" Use, i.e., for other indications that have as yet not
been approved. Newer drugs are projected as safer and more effective, even if
they are not so, and are much more expensive than existing drugs. Bad publicity
for older existing drugs, or their generic equivalents, is given if patent protection
period is over and they are cheaper as well as effective.
Mosher et al elaborate how the prescriber base is expanded: to maximize profits
from expanded market of SSRI's, mental health medications, even those with
potentially serious adverse effects were aggressively promoted, not just with
psychiatrists,
but
with
primary care
physicians,
gerontologists
and
even
pediatricians. Sales representatives systematically projected them as "safe,
effective and well tolerated" as compared to older drugs. The impression
effectively communicated was that these agents were safe to use among youth,
11
nonpsychotic persons and in the elderly. While earlier neuroleptic drug treatment
was recommended for schizophrenia only with active clinical symptoms which
were indicative of psychosis, the drug company "agenda
setters" were
determined to expand the market by promoting the concept that the "prepsychotic phase of schizophrenia required preventive treatment with their new
drug".
The ten-fold increase in the use of antipsychotic drugs by the under-18 population
in the US in the last decade is a stark testimony to the strategic and aggressive
marketing approach. Harnessing of support groups for relatives of people
suffering from schizophrenia for 'advocacy coalitions' that were dependent on
company sponsorship, has been another marketing strategy. Orchestrated media
hype projecting the wonders of these 'breakthrough drugs' with articles written
£
by 'paid experts' and ghost writers, has been another strategy. The Eli Lilly funded
PR strategy through World Psychiatric Association (Rosen et al 2000) and NAMI
(Silverstern 1999, Oaks 2000 pg 14) to mount an anti-stigma campaign has been
another marketing strategy. The anti-stigma campaign was not for 'advocating
elimination of stigmatization against those suffering from schizophrenia', but
elimination of stigmatization against people diagnosed with schizophrenia so long
as they are taking their medication (by force if necessary).
•
Involuntary treatment is an essential part of expanding the market
for Schizophrenia medications. The market for Schizophrenia drugs
is a fast growing $ 5 billion a year market.
•
The system of representative democracy is being reshaped into a
new kind of 'managed corporatocracy' in which public opinion and
government policy are custom made products ,that can be shaped,
packaged and sold by skilled public relations experts.
Loren R. Mosher, Richard Gosden, Sharon Beder 2004. 'Drug Companies &
Schizophrenia:
Unbridled
Capitalism
Meets Madness' in Models of
Madness: Psychological, Social and Biological Approaches to Schizophrenia
edited by John Read, Loren R. Mosher & Richard P. Bentall, BrunnerRoutledge New York pg. 115-130.
™
MS (3
The pattern in India is very much the same: over prescribing medicines related to
the mind would obviously have significant implications as they are often
prescribed by large number of medical personnel who have little understanding of
the various mental health disorders, nor about the numerous drugs flooding the
market drugs which are aggressively sold and promoted.
Moynihan, Heath and Henry write, "There's a lot of money to be made from
telling healthy people they're sick. Some forms of medicalizing ordinary life may
now be better described as disease mongering: widening the boundaries of
treatable illness in order to expand markets for those who sell and deliver
treatments. Pharmaceutical companies are actively involved in sponsoring the
definition of disease mongering and promoting them to both prescribers and
consumers. The social construction of illness is being replaced by the corporate
construction of disease". (Ray Moynihan, Iona Heath, David Henry 2002, in 'Selling
Sickness: The Pharmaceutical Industry and Disease Mongering' BMJ 324 (7342):
886-891)
With the formulation of India's National Health Policy 2015 on the anvil, the
Mental Health Policy having been announced in 2014, and the possibility of a
National Pharmaceutical Policy as well as the National List of Essential Medicines
2015 being in the process, it would be important to see that those needing
mental health care receive care which is rational, non-exploitative, humanized
and sensitive, and it is delivered with dignity of those needing care kept intact.
Curtailing unethical marketing practices of pharma companies requires legislation
& their implementation, as what exists today are mere voluntary codes, whether
it is WHO guidelines, or voluntary codes of pharma companies, or the
International
Pharmaceutical
Manufacturers Association
(IPMA), which are
constantly violated. Medical Council of India makes taking of gifts & favors illegal,
but rampant violations not only exist but are systematically increasing. The price
paid is by the public, many of whom are denied the medical & mental health care
that they need &others are recipients of medicines which are over prescribed or
13
irrationally prescribed. As MFC our efforts towards resisting exploitation in the
name of medicine, & promotion of humanized, comprehensive care will have to
continue.
References
1. Lisa Cosgrove and Harold J. Bursztajn 2010. 'Undue Pharmaceutical
Influence on Psychiatric Practice' Psychiatric Times May 18.
2. Loren R. Mosher, Richard Gosden, Sharon Beder 2004. 'Drug Companies &
Schizophrenia: Unbridled Capitalism Meets Madness' in Models of
Madness: Psychological, Social and Biological Approaches to Schizophrenia
edited by John Read, Loren R. Mosher & Richard P. Bentall, BrunnerRoutledge New York pg. 115-130.
3. Marcia Angell 2000. 'Is Academic Medicine for Sale?' New England Journal
of Medicine.
4. Marcia Angell 2005. 'The Truth about the Drug Companies: How they
deceive us and what to do about it. Random House pg 145-146.
5. Peter Whoriskey 2012. 'Antidepressants to treat Grief? Psychiatry panelists
with ties to drug Industry say Yes' The Washington Post December 26.
6. Ray Moynihan, Iona Heath, David Henry 2002. 'Selling Sickness: The
Pharmaceutical Industry and Disease Mongering' BMJ 324 (7342): 886-891
7. Sidney M. Wolfe et al Public Citizen Health Research Group 2005. Worst
Pills, Best Pills: A Consumer's Guide to Avoiding Drug Induced Death or
Illness, Pocket Books.
14
psychiatry could survive without it. The pharmaceutical industry owns the data
from clinical trials it supports, decides which studies will be published, chooses
authors, ghost writes articles and revises them to present the best possible
interpretation of the data (Angell 2000).
Angell writes: "The ties between clinical researchers and industry include not only
grant support, but also a host of other financial arrangements. Researchers also
serve as consultants to companies, whose products they are studying, join
advisory boards, speakers bureaus, enter into patent and royalty arrangements,
agree to be listed authors of articles ghost written by interested companies,
promote drugs and devices at company sponsored symposiums and allow
themselves to be plied with expensive gifts and trips to luxurious settings. Many
also have equity interest in the companies." (Marcia Angell 2000. 'Is Academic
Medicine for Sale?' New England Journal of Medicine)
I Marketing masquerading as education at professional meetings: Many
big professional meetings resemble bazaars dominated by garish drug
company exhibits and friendly sales people eager to ply doctors with
gifts, while they
pitch their companies'
drugs.
Instead of sober
professionalism the atmosphere of these meetings is now 'trade show
I hucksterism.'
A reporter from Boston Globe described her encounter with one
psychiatrist
at
the
annual
meeting
of the
American
Psychiatric
Association (APA): As a reward for attending the APA's annual meeting
the psychiatrist had received a small egg shaped clock from makers of
antidepressant Prozac; sleek thermos from Paxil, also an antidepressant;
and an engraved silver business card holder courtesy of Depakote, an
anticonvulsant (often prescribed for off-label use for a variety of
psychiatrist disorders). She got a neat CD carrying case from Risperdol,
an anti-psychotic. Her fare, and that of 30 others to the US from her
country, had been paid for by Pfizer.
Marcia Angell 2005 The Truth About the Drug Companies: How They
Deceive Us and What To Do About It pg 145-146.
In the words of Joanna Moncrieff and Phil Thomas, "The influence of the
pharmaceutical industry is particularly pernicious where the possibilities for
colonizing ever more aspects of human life are potentially limitless. [...] The
financial muscle of the pharmaceutical industry has helped to tip the scales in
favour of a predominantly biological view of psychiatric disorders. This has
submerged alternative therapeutic approaches, despite the fact that user led
research indicates that service users find a wide variety of non medical
approaches valuable in coping with emotional distress." If this is the situation in
one of the supposedly better regulated pharmaceutical markets, it is scary to
imagine what must be happening in other countries, where non access to
essential medicines, and to unbiased information occurs along with overuse,
irrational use and misuse of many of these Drugs, where Post Marketing
Surveillance, Drug Utilization Studies, Rational Use of Drugs rarely take place.
o
Big Pharma (the Multinational Pharmaceutical World) as it is known,
offered everything, the hopes and dreams we have of it; its vast, partly
realized potential for good; and its pitch dark underside, sustained by
huge wealth, pathological secrecy, corruption and greed.
•
Big Pharma is also engaged in the deliberate seduction of the Medical
Profession country by country, worldwide. It is spending a fortune on
influencing, hiring and purchasing academic judgement, to a point
where, in a few years' time, if Big Pharma continues unchecked on its
present happy path, un-bought medical opinion will be hard to find.
•
When giant pharmaceutical companies donate whole biotech
buildings and endorse professorships at Universities and teaching
hospitals, where products are tested, and developed, effect on the
supposedly impartial academic medical research could not be non
existent.
•
A matter of deep concern is the increasing alarming reports where
inconvenient scientific findings have been suppressed or rewritten and
those responsible for them hounded off their campuses with their
professional and personal reputations systematically trashed by
machinations of public relations agencies in the pay of the pharma.
John le Carre 2001, Essay 'In Place of Nations' in magazine The Nation
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