Ill informed: how drug companies convince Americans they're sicker than they are

Washington Monthly, Dec, 2005 by Shannon Brownlee

The industry now spends on the order of $3 billion on DTC advertising, and sees $4.20 in return on every dollar invested in "driving patients to their doctors' offices." The result has been rapidly rising pharmaceutical drug use. In 1993, the average number of prescriptions filled per person per year was seven. In 2000, it was 11; it was 12 four years later. Some 27 percent of elderly Americans are on nine or more medications simultaneously, compared with 17 percent in 1997.

While our national prescription drug habit costs us nearly $200 billion a year, it isn't necessarily a bad thing if it's improving our health, which the pharmaceutical industry argues it is. Americans benefit from its products, says the industry, by living longer, suffering fewer symptoms of disease, and spending fewer days in the hospital. To be sure, pharma has been the source of many medical miracles--longer lives for people infected with HIV, thanks to anti-viral drugs, and less suffering from everything from migraines to mumps. That's not the issue here. The problem with the drug industry, as Critser and others see it, is that its marketing techniques are leading too many Americans to take one of the following: a risky drug for a relatively mild condition; a more expensive drug when a cheaper, equally effective one would do; a drug for a condition that would be better treated in other ways; or a potentially dangerous combination of drugs.

This state of affairs has come to pass, in Critser's views, in part through the medicalization of more and more aspects of ordinary life. Marketing has persuaded both doctors and patients that uncommon conditions, like GERD, are widespread, while insignificant or merely troublesome complaints are serious if not life-threatening, and need to be treated with a potentially dangerous drug. Many of us now demand drugs not only for serious illnesses, but also for everything from allergies to toenail fungus. Meanwhile, risk factors like high cholesterol and lower-than-average bone density are portrayed by the industry as diseases in and of themselves, and in need of treatment with drugs that can themselves cause life-threatening conditions.

Implicit but to a certain degree unexplored in Critser's analysis are the ways in which doctors have played a pivotal role in the overselling of prescription drugs. They often accede to patient demands for heavily-advertised brand name drugs even when no drug is needed, or a less expensive, less dangerous drug will do. They have also permitted the industry to commandeer continuing medical education, the courses doctors are required to take to maintain their licenses, the majority of which are now underwritten by pharma. Big pharma, and to a lesser degree biotech, now funds 57 percent of clinical trials, the scientific tests that are designed to probe the efficacy and safety of drugs. Providing the funds for this research has given the drug industry unprecedented leverage over what doctors and patients know--and don't know--about drugs, and allows it to systematically and deliberately manipulate data. Critser describes several examples of how the financial relationships between physicians and pharma have led to patient harm, but he seems to lay most of the blame at the feet of industry, which in many ways is simply doing its job making money for stockholders.