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Veteran NEJM Editor Takes on Big Pharma

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Veteran NEJM Editor Takes on Big Pharma The Agony of Bangkok line The Irony of Bangkok From the Treatment Action Group (TAG): Marcia’s Manifesto: Saving Pharma from Itself A monthly paper of research and policy TAGline en español Volume 11 Issue 9 September 2004 Prescription for Profits Party Pooper The Agony of Bangkok Thai Activist Exhorts Veteran NEJM Editor I find it hard to imagine that a system this corrupt can be a good thing, or that it is worth Conference Crowd To Takes on Big Pharma As the vast amounts of money spent on it. In addition, we have to ask ourselves whether it Stand Firm Against U.S. No One Before; Calls for really is a net benefit to the public to be taking so many drugs. In my view, we have become Patent Regime and Sweeping Reforms an overmedicated society. ‘Masks of Fake Concern’ Marcia Angell, MD, August 2004 The Truth About the Drug Companies: How ‘Weaning us off the dope’ They Deceive Us And What To Do About It ‘Trading away health’ Just as the hand-wringing PR exer- The following is the text of an cise that has become the interna- TDM, ¡Stat! address delivered by Thai AIDS tional AIDS conference was wind- Treatment Action Group director ing down halfway across the Paisan Suwannawong at the open- globe, this little item hit the news- Más Mezclas ing ceremony of the 15th stand in the states: Rechazadas International AIDS Conference which Debido A took place in Bangkok this summer. July 15, 2004—Members of a gov- Special thanks to Paisan for his per- ernment panel, which earlier this Preocupaciones Por mission to reprint. week recommended more aggres- Concentración sive use of statin medications for * * * ood evening, ladies, gentlemen, people at the highest risk of dying from heart disease, failed to dis- ‘Combos locos y explosivos’ Gand friends. Welcome to close financial links to the compa- * * Bangkok. Sorry if I am a little ner- nies that make the drugs. vous, but I am not used to speaking on stage; I am more experienced The revised consensus guidelines Yasmin Halima y Rob Camp with speaking on the street. First, I were issued by none less than the asistieron al Taller de would like to say thank you to the American Heart Association and Farmacología de un día de people who supported my invitation were drawn up by a government duración que se llevó a cabo to speak, and thank you to the panel of experts in the field, con- inmediatamente después de la International AIDS Society because vened by the NIH’s own National Conferencia 2004 sobre Retrovirus. it means a lot to me to be able to Heart, Lung, and Blood Institute. Aquí reproducimos el informe que speak here from the perspective of a The new rules, if sustained, would prepararon acerca de algunas com- drug user living with HIV. lower serum cholesterol targets to binaciones locas, por no decir a point where 7 million more explosivas. Agradecen a todos los I would like to tell you a little bit Americans would be encouraged to presentadores por haber revisado about myself. I grew up in one of start taking the cholesterol lower- su información. Bangkok’s biggest slums, not far ing medications of Pfizer, Merck, from here. I saw many people using BMS and AstraZeneca. (At $3,000 Statins + HAART drugs, but never imagined that I a year and 20-30% margins, we’re Muchas personas VIH+ están sien- would become a drug user myself. talking an additional $4-6 billion a do tratadas actualmente con drogas The first time I smoked marijuana, year in profits—with little more de statin para manejar el aumento it felt like a challenge because all than the stroke of a pen.) de los lípidos. Es esencial compren- the public campaigns said drugs der las interacciones farmacológicas were “bad” and “dangerous.” I found New York Newsday first reported entre los statins y las drogas de it wasn’t true, so I continued to — continued on next page — — sigue en la página 13 — — continued on page 5 — — continued from first page, col. 1 — most egregious of these marketing- the story in its Thursday edition. masquerading-as-medicine maneu- It Wasn’t Always Like This Eight of the nine panel members vers. In fact, the two notable revi- The Truth About the Drug Companies had earned money specifically sions to HIV’s standard-of-care fol- [excerpts] from cholesterol drug makers, lowed on the heels of therapeutic including Pfizer, Merck, BMS and setbacks (results of the early vs. There used to be something faintly disreputable AstraZeneca. The NIH’s Dr. James about really big fortunes. You could choose to do deferred AZT “Concorde” study, well or you could choose to do good, but most peo- Cleeman and Dr. Rose Marie circa 1993; and the failure of the ple who had a choice in the matter thought it diffi- Robertson, of the AHA, both said eradication hypothesis, around cult to do both. That belief was particularly strong among scientists and other intellectuals. They could they felt financial disclosure had 1998) and resulted in retrench- choose to live a comfortable but not luxurious life in been covered because all but two ment rather than new aggressivi- academia, or they could “sell out” to industry and do less important but more remunerative work. One of the authors had also served on ty—albeit not without sustained of the results has been a growing pro-industry bias the 2001 consensus panel—and intervention to limit the damage. in medical research... and CME programs—exactly that they had made their industry where such bias doesn’t belong. (page 8) connections known then. But might that portion of the Big Many members of the FDA’s eighteen advisory Pharma enthralled research and committees have financial connections to interest- ed companies [see page 7 of this issue]. Although he summer imbroglio set famil- treatment establishment still be there are conflict-of-interest rules that prohibit par- iar alarm bells sounding: foxes clinging onto a model of overmed- ticipation in such cases, the agency regularly T waives them on the unlikely grounds that some- guarding the hen house, physicians icatization in order to please its one’s advice is indispensable. (page 210) and researchers as pharma shills. industry pimps? After all, the NIH’s Med ed writers and circuit speakers are often paid Of course, guidelines meddling is hallowed Principles of consultants for the drug companies. They are usu- among the oldest tricks in the Big Antiretroviral Therapy seem ally required to disclose financial ties [see page 8 Pharma playbook. The wisest, per- immune to re-evaluation—even (web version only, of this issue], and that disclo- sure is supposed to make it acceptable that they haps privileged, clinicians routinely though the science and hypotheses have them. But drug companies or their agents, the eschew such interference and hope on which they were based have MECCs, often suggest the topic and speaker—and even put together the slides. (page 140) nothing untoward will befall them largely been overtaken by events. for their brave and educated inso- “It’s the virus, stupid” sprang from It’s hard to believe that close and remunerative per- sonal ties with drug companies do not add to the lence. But the fact remains that its en-coffined slumber on the strong pro-industry bias in medical research and guidelines of all guises in all special- wings of hope—fueled by the rally- education. Big pharma not only controls the details ties whack quite a wallop in estab- ing cries of medical marketers— of the way clinical trials are performed, but as backup, it also works to win the hearts and lishing prescription patterns and the and has since taken on a life of its minds of researchers. (page 104) standard-of-care. And thus, not own. But where the silver dagger Drug companies are extremely generous to doctors unlike the Swiftboat veterans’ to return it to its repose? in their ‘education’ activities... Doctors are invited to media blitz in swing electoral states, dinners in expensive restaurants or on junkets to luxurious settings to act as ‘consultants’ or ‘advi- efforts to influence them suck in tens When otherwise patient friendly sors.’ The doctors listen to speakers and provide of millions of dollars a pop. researchers and community docs some minimal response about how they like the self-satisfyingly state, with all the company drugs or what they think of a new adver- tising campaign. That enables drug companies to Perhaps due to an historic vigi- authority their years of furtive phar- pay doctors just for showing up [$1,000 a pop for lance among AIDS activists and ma hustling has bought them, before the coveted high prescribers as of August 2004]. Participants may also receive training to serve on clinician advocates (or to its infec- a conference crowd that “lifelong speakers’ bureaus, so that they too can become tious nature), the field of HIV medi- antiretroviral therapy is not really a company shills. p141 cine has so far been spared the problem (anymore) because easier to Such gifts would trigger a red bribery take, less toxic combos are now alert in the mind of just about any pub- Pharmaceutical Industry Revenue available or just over the horizon”; lic official or government contractor. But † and Expense Breakdown, 2002 when Trizivir and Viread+Sustiva or not, it seems, in the minds of many doc- Kaletra are considered treatment tors. (page 128) sparing “maintenance” regimens in Research Why do doctors pretend they believe drug compa- virtually all the studies pretending to nies are interested in education? (Some of them & Development $31 billion re-explore this approach (see inset, actually believe it.) The answer is: It pays.
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