Drug safety 101

Nutrition Health Review, Spring, 2003

This is Part Two in an editorial series dealing with pharmaceutical companies. Part One can be found in Nutrition Health Review #84).

If you have ever had any sort of health problem--anything from high blood pressure to a few sneezes in the springtime--chances are you have encountered a prescription drag with a familiar brand name. If your physician has ever examined a patient with any sort of health problem, chances are he or she is familiar with a certain brand name, as well. Both of you may feel comfortable and confident with the brand name, but only one of you is on the drug maker's payroll.

Every day in America, physicians blur the line between unbiased healers and corporate shills. Their intentions may be noble, but the subconscious grasp of the pharmaceutical industry may be putting your life and the lives of your loved ones at risk. It is not uncommon for a pharmaceutical company to stage elaborate seminars that are no more than multi-million dollar, disingenuous, infomercials. For example, at a recent convention of the American Psychiatric Association, 14,000 doctors flooded Philadelphia

in order to "learn" about the latest drugs for their patients.

One exhibit put on by Janssen Pharmaceutica, whose drug Risperdal[R] (risperidone) is used to treat schizophrenia, set up a virtual reality "bus" that was designed to show psychiatrists how a patient with schizophrenia feels. Apparently, the many years spent in medical school had not prepared them to deal with this relatively common disease. The idea, as described by Janssen, is that the "rider" on the bus is supposed to be a patient who has gone too long without his or her medication. The bus' destination, according to the exhibit, is the pharmacy. Voices call out from all sides, the bus appears to swerve, and the visual images become distorted. At the end of the ride, the virtual bus driver looks at the rider and says, "Hey, you don't look so good; maybe you should have gone to the pharmacy sooner."

These perks have raised the eyebrows of both the American Medical Association (AMA) and Congress, which continually review the AMA's 12-year-old ethical code of accepting girls. The leeway offered by these ethical codes, however, is astounding.

Doctors are often made "advisers" to pharmaceutical companies, sometimes for as little as a few hours at a time. As advisers, they are able to receive large payments and travel expenses. Forest Laboratories, Inc. calls its bankrolled physicians "advertising/marketing consultants" in their confidentiality agreements.

Physicians are not machines. If presented with free food and activities, no one could begrudge them their willingness to accept. It is the fact that they leave these conventions and events with a tendency, albeit a possible subliminal one, to prescribe first a medication with an unclear safety record that may be fresh in their minds that puts patients at risk. In addition, the patients may already be at risk because of the barrage of cartoonish advertisements they are confronted with each day.

The power money has over certain doctors is certainly nothing new. Dr. Morris Fishbein was appointed head of the AMA in 1924 after failing anatomy in medical school and without ever seeing a patient. By 1934 he assumed complete control of the company and made life very difficult for doctors who did not wish to join. In addition to his dictatorial control over licensing boards, he bullied a young inventor named Royal Raymond Rife into bankruptcy after Rife was using a successful treatment for cancer that would have ultimately put a lot of doctors out of business. Dr. Fishbein vandalized Rife's equipment, destroyed his laboratory, and confiscated fifty years worth of research. Researchers today are still trying to replicate Rife's results, but as of yet they have been unsuccessful.

Dr. Fishbein also decided which drugs could be sold to the public based on how many advertising dollars were funneled into the Journal of the American Medical Association. Using the leverage of this prestigious journal, he extorted as much money as possible from pharmaceutical companies. Drugs were not always sufficiently tested; the decision to sell to consumers was largely based on Fishbein's opinions.

The tyrannical hold of Dr. Fishbein has long since ended, and the system of checks and balances within the pharmaceutical industry has made for a much safer consumer market, but the question still remains as to why the AMA still offers a fellowship named after Dr. Fishbein. Buildings are still dedicated in his honor to this day as well. Is this a glimpse into the true value system of the pharmaceutical companies?

Another potential ethical dilemma lies with direct-to-consumer (DTC) pharmaceutical advertising. DTC is a multimillion dollar industry designed to inform consumers about certain drags that can be used to treat whatever ailment they have or think they have. Generally, these ads paint a picture of utopian living following the ingestion of tiny, bright-colored pills. Serene settings and broad smiles are the norm, followed by a speedy, breathless, and incomplete recitation of side effects. It would be ridiculous to expect that that an ad for a certain drag focus on its potentially fatal risks, but these omissions could put a greater strain on doctor-patient relationships.