We don’t necessarily think too much about it, especially when we are in good health…. This might not be such a surprise but unhealthy people are an important source of business, starting from the medicines.
The health care business
Up to just after World War II, pharmacists were preparing medicines on the basis of a prescription that a doctor would give. Their studies and their professional skills were dedicated to that. The relative simplicity of the at-the-time practicable chemistry processes justified this approach and explains why it was reasonable to implement them in a private practice. With time, the profile of the pharmacist has fundamentally shifted, moving towards a retailer of pharmaceutical industry products.
To be honest, shifting the ownership of the practical production from a small private laboratory (most of the times: one individual) to a large industrial plant does not look necessarily worrying: the intellectual property about the content of the medicines is far more important. On this point, the shift here has moved from the doctors to the pharmaceutical companies.
Where is the progress?
One would assume that a big company has more resources than an individual to fund a proper research on the discovery and design of innovative and improved medicines. Therefore, there is a reasonable expectation to see a significant increase in the availability and effectiveness of the drugs that we are prescribed.
Every year since (at least) 1981, the independent French “Revue Prescrire” examines all the medicines submissions to the French regulator and reports statistics on them. According to their reports, 4172 new medicines or indications have been submitted for approval in France between 1981 and 2012; and this number excludes copies. This seems to indicate a field of flourishing innovation! Unfortunately, more than 80% (3354) of them were bringing a minimal or no advantage. More than 10% (431) were either poorly documented (even if no final determination was made, the insufficient documentation is an issue on its own right) or presented real or potential disadvantages over existing therapies! Only 9 (0.22%) were a major therapeutic advance!
These numbers clearly show that there is fundamentally no innovation and no real progress!
Suspect business practises
No doubt that this generates suspects. Profit is legitimate and desirable for pharmaceutical companies: how this profit is created generates suspicion and ethical questions. The above figures demonstrate clearly that making profit has a heavier weight than providing better cures: otherwise, what would be the point of discovering new drugs that present “minimal or no advantage”? Maybe there are elements of deception: just presenting a drug as “new” suggests an improvement and this will justify higher prices – thus higher revenue – regardless on whether this progresses the cures (there is no need to comment situations where insufficient documentation is disclosed or disadvantages are introduced)….
Unfortunately, there is more. Marc-André Gagnon, in his article (in French) for “Revue Prescrire”, reports of research being organised as a campaign and of scientific data used to support sales instead of improving prescription practices. According to his article, this goes up to appointing ghostwriters to divulge the properly biased information to give the impression that multiple sources (their independence is implied but not verified) have confirmed it: you will notice barely no research and no data proving that some drugs are problematic or useless. There are also examples of free-lance researchers and journalists being threatened, in order to avoid some of this information to reach the public (among others, the case of Irène Frachon). The article goes deeper in this topic, with more facts and examples.
This information is anyway public: the biggest names in the pharmaceutical industry have been fined billions of dollars (no typos: billions!) for such practices, starting with GlaxoSmithKline with 750 millions dollars for poor manufacturing practices in 2010 and 3 billions dollars for off-label promotion and failure to disclose safety data in 2012. To represent properly the size of the problem, in 2012, GlaxoSmithKline has a revenue exceeding 26 billions dollars, with an operating income of more than 7 billions and a net income of just less than 5 billions, despite the fine….
Manipulation of knowledge
Practices have now leaped forward.
Most of us interact with this world through practitioners, whose professional skills are updated in congresses and through studies that are fully financed by the major pharmaceutical companies. Manipulating the knowledge of these health care professionals ensures that not only unbelievable amounts of income is generated but that the practitioners will support the model for the companies, and it becomes more difficult to prove any misbehaviour.
The case of Swiss company Serono (now part of Merck KGaA) is exemplary: one of their products, Serostim, is a growth hormone and the company volunteered to provide practitioner with the technological tools to assist them in the decision on whether prescribing the drug or not. The (very) short story is that, in 2005, Serono settled a case in court for 704 millions dollars because the decision tool was biased; these were 28% of their revenue that year….
“Health care” starts having a different meaning now…. Awareness is the key word. Otherwise, who’s taking care of your health?
The Internet provides some information: the HAI (Health Action International) web site is dealing with the topic as it is recognised for its global medicines policy expertise and as a non-profit, independent, worldwide network of over 200 members including consumer groups, public interest NGOs, health care providers, academics, media and individuals in more than 70 countries.
The best way is to get the information from the source; I’d recommend Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients by British physician and academic Ben Goldacre about the pharmaceutical industry, its relationship with the medical profession, and the extent to which it controls academic research into its own products. The Economist described the book as slightly technical, eminently readable, consistently shocking, occasionally hectoring and unapologetically polemical. (….) This is a book that deserves to be widely read, because anyone who does read it cannot help feeling both uncomfortable and angry.
Next time your GP tells you that you’d better use a new drug that just came in the market, you know what’s really happened. Or not?
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