In some ways, it is very difficult to publicly criticize the corporations that sell drugs. They are literally saving lives, so how dare you question how they go about it? These are the people who are busily working every day to find cures and treatments both for age-old illnesses like cancer, as well as the emerging diseases that frequently cause a minor panic when they crop up.
Actually, all healthcare companies aren’t equal. Much of the actual innovation is done by biotech startups who gamble that a certain line of research might just pay off. Once the groundwork is done and it’s been demonstrated that a certain compound might be clinically effective, a much larger multinational (typically valued at over $100 billion) will probably take over. Due to their size, these giants don’t need to bet the farm on a new product the way smaller R&D outfits do, and unlike them have the financial muscle to push promising treatments through the extensive testing regulatory approval requires.
While smaller biotech companies tend to either win big or crash heavily, large, mature pharma companies offer returns which are consistently well above the market average. Put another way, although green-field research is a risky proposition, a mature company with over a hundred trials in progress, and dozens of established product lines, is a very stable entity. Pharmaceutical corporations, along with banks, have some of the highest profit margins of any publicly traded enterprise. They may be saving lives, but they’re turning a healthy profit doing it, and some of the industry practices are less than praiseworthy.
Sidelining Alternative Treatments
The World Health Organization lists several dozen clinical conditions for which acupuncture is an effective treatment, yet it’s a rare MD who will prescribe needles which don’t come with a syringe attached. Similarly, non-chemical treatments ranging from the basically screwy to the possibly worthwhile exist, but without the massive sums needed for research and marketing, we’ll never know which of these are effective.
In the same vein, conditions which are heavily influenced by lifestyle are killing more people than ever, yet the fundamental causes are often downplayed. While diabetes, heart disease, psychological maladies and a variety of syndromes linked to obesity can be alleviated or cured by improved nutrition and exercise, many patients are conditioned to think that a pill is a quicker and easier solution, leading us to:
If a medicine is recommended or prescribed by your doctor, you have at least a decent chance of it a) being effective at treating your condition, and b) not being likely to cause significant harm. However, even drugs available over the counter can have side effects, which may be especially severe in certain individuals or when combined with other forms of medication.
The strange truth is that the pharmaceutical industry actually spends more on marketing than research. In the U.S. alone, this spending tops $30 billion annually. While it’s difficult to find fault with the legitimate promotion of a drug based on its performance and track record, this is often not the point of advertising. Marketers may encourage a chemical solution to a non-pharmacological problem such as obesity, or subtly encourage long-term use of substances meant for occasional symptomatic relief. This can result in addiction even in the case of non-prescription medicines.
Another questionable tactic is the ways sales representatives of pharmaceutical companies go about promoting their products directly to doctors. It’s a proven fact that being given free samples (called “detailing” in the industry) affects the way doctors approach their work, for instance making them more likely to prescribe brand-name medication instead of cheaper generic equivalents.
A number of guidelines and regulations have been put in place to prevent undue influence by drug reps on doctors, such as limitations on providing gifts and entertainment. Some doctors refuse to see reps outright, or only when invited to discuss a certain product. Still, the pharmaceutical industry wouldn’t be shelling out large amounts of money on marketing if it wasn’t working – whether this is generally to the benefit of patients is debatable.
Frequently Breaking the Law
For an industry that seems to automatically perch on the moral high ground, large pharmaceutical companies sure spend a lot of time in court. Virtually every corporate press release contains a paragraph on how important patients’ well-being is to them, though this doesn’t seem to translate into practice.
Pfizer was recently fined £84.2m for overcharging the British National Health Service. This happened when they increased the price of a popular anti-epilepsy drug by 2,600% practically overnight. GlaxoSmithKline had to pay $3 billion in 2010 for misdeeds ranging from paying kickbacks to doctors who prescribed their drugs to reporting false safety information about their products. All told, large pharmaceutical corporations were fined over $11 billion between 2012 and 2015 in the United States alone, often for advertising their products for use in an unapproved way or on an unapproved age group.
While these sums may seem eye-poppingly large, the fact is that a few weeks of sales are all that’s needed to make up for them. While this remains the case, it still makes sense, from a business perspective, to cut the occasional corner when you can.
Though it wouldn’t do to make any specific allegations in this forum, the public should be aware that the medical profession is a tightly knit community. There are only a limited number of top schools and only a limited number of places where medical researchers can find employment. People within the industry – whether they work in hospitals, in government, in academia or in the pharmaceutical industry – keep in touch with the latest developments, and each other, at conferences and seminars. Medical research is enormously expensive, so any biochemist or molecular biologist wanting to gain a postgraduate degree needs to find someone to sponsor their work.
All these conferences, research, and teaching has to be paid for somehow, and it would be naive to assume that the donor with the deepest pockets doesn’t gain influence on some level. While pharmaceutical companies don’t get to rewrite the university syllabus or dictate whether research results are published or not, even the richest establishments have budget constraints, and even a subconscious inclination to please your funder can have notable effects. Cases, where more direct pressure was exerted, are also not unknown.
If this isn’t enough for you, consider the relationship between government regulatory and research organizations and big pharmaceutical companies. It seems that barely an eyebrow is raised when a former CDC (in charge of vaccine policy) director gets a new job at Merck, a major vaccine manufacturer. Or when a former NIH director, who also happens to be involved with a number of influential bodies, joins Sanofi-Aventis. These individuals and many others in a similar position may be very good at their jobs and have the highest personal ethical standards. Even assuming this is true, where do you think their sympathies lie: with faceless patients or the people they see every day?
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Swallowing a pill to make you thinner, another to make you calmer and a third to make you happier is really not a winning life strategy. Many illnesses come from within, either by directly influencing your physical state or by causing behaviors that impact your health negatively. Taking care of the root problems should be a higher priority than finding a new unpronounceable drug, and therapy is now easier to get than ever; especially with online services from companies like BetterHelp and others.
The above list is only a small sample of the complaints the public can level against drug suppliers. The way the modern medical industry works were never designed but came into being in fits and starts. The system we see today is quite possibly not the best conceivable from patients’ viewpoint, particularly poorer ones. It’s time to recognize that everybody involved has their own set of interests, which may or may not align with those of society at large. In what ways such an entrenched system can possibly be reformed is an interesting dilemma with no easy answers.