Our Daily Meds

Citation

Kay, M.J. (2009), "Our Daily Meds", International Journal of Pharmaceutical and Healthcare Marketing, Vol. 3 No. 3, pp. 294-296. https://doi.org/10.1108/17506120910989697

Our Daily Meds is an in‐depth examination the marketing practices of the pharmaceutical industry. It is certainly a must read book for the readers of this journal, as well as anyone involved in health care practice. Written by a veteran NY Times journalist, the book provides a focused and forceful polemic on the failures of this industry as it has developed over the last 50 years.

Peterson weaves together a collection of case examples, documenting abuses that are each ineluctably disquieting. In the process, she illustrates how profits have come to take precedence over the goal of scientific discovery. As she states in the introduction, “In too many cases, whether a medicine helps or harms a patient has become secondary to how much it will bring shareholders in profits” (p. 11). This is the quintessential problem of an industry with divided goals – the imperative to “sell more” too often conflicts with prudent medical care and sound moral judgment. Examining the techniques of marketing applied to the promotion of medicine, this book provides ample support to the contention that the pharmaceutical firms are profiteering at the expense of Americans.

Advertisers have long been highly successful in increasing sales for supposed medical “cures” of myriad varieties. Peterson notes in Chapter 1 that Gerald Lambert was able to increase the profits of Listerine 40‐fold in 1921 – this was done by marketing the mouthwash as a cure for the mythical disease known as “halitosis” (or bad breath). Consumers have revealed themselves to be far too vulnerable to readily accepting treatments for concocted “maladies” that have long been considered a normal part of the human lifecycle – including baldness, shyness, “too frequent” urination, and of course, erectile dysfunction. It is not only the drugs, but also it is disease conditions that have been branded and aggressively marketed – and too readily accepted, even to those within the medical community.

It would be facile to write off the evidence collected in the book as “merely anecdotal” or exaggerated. Facts, figures, and references are too ample and too well documented. Chapter 2 cites the industry's own scientists, executives, and clinical studies to establish that most – yes, most drugs are not effective for a large proportion of the people who take them. One study of 14 diseases found that medicines worked for as few as 25 per cent of patients. And from 30 to 70 per cent of patients today get no benefit from taking statins – the supposed “miracle” drugs developed to lower cholesterol.

This data on the lack of efficacy of medications is, of course, disquieting. Drugs have certainly fueled the continuing rise in medical costs, but even more troubling are the issues of the harm that aggressive promotions (and the resulting over‐prescription of drugs) have had. In Chapter 3, Peterson acutely examines the sharp rise in psychiatric medications prescribed to children in her native state of Iowa. One reads with dismay of the growing use of powerful behavioral drugs, such as Ritalin and Prosac, spurred on by the plethora of newly “discovered” psychiatric disorders. These are prescribed with ease, the process being facilitated by industry‐funded “information” and “education” programs for doctors. Substantial prescription drug use in combination goes unchecked, even though little medical research studies drug interaction effects.

The development of the life‐saving medication, penicillin, saved literally thousands of lives in World War II. But by the 1950s, many of the supposed miracle drugs that were developed and marketed, such as thalidomide, proved to have adverse, or even ruinous, side effects and complications. Clearly, there is need for oversight in the industry, but the history of the matter is rather bleak. Regulation was non‐existent in the industry until as late as 1938 when President Roosevelt signed the Food, Drug and Cosmetics Act. This law finally required that new drugs actually be tested to scientifically prove their efficacy. However, the test of efficacy remains merely the comparison to a placebo.

For the last 50 years, pharmaceutical firms have synthesized thousands of new chemicals. Yet, the results have rarely led to significantly better treatments. Companies have instead developed drugs that are merely chemically “different” enough to get the firm a patent. The many new drugs developed are barely distinguishable from each other in terms of their efficacy. And in spite of all of this competition, prices have remained high. Moreover, the pharmaceutical advances that have occurred have more frequently been built upon publically funded university research, not the pharmaceutical industry's own efforts.

The truly skeptical reader could remain stubbornly unconvinced of the shortcomings of the industry – that is, until reaching Chapter 6. Here, the author exposes the widespread practice of the ghostwriting of “scientific” research articles. One learns that there are many different ways for a study to be designed to generate data to sell a drug. With the aid of advertisers and public relations firms, the pharmaceutical industry has overtly recruited physicians and scientists with the singular purpose of getting their drugs approved.

Though editorials in the top medical journals may have decried this practice as corrupting, apparently nothing prevents doctors from being paid to approve ghost written publications in their name. The problem is that these articles are cited by researchers conducting related or similar studies, thus distorting the peer review research system that is the basis of scientific progress. A significant numbers of doctors now accept fees for sundry bogus consulting, research, and referral services. They have thus become complicit in facilitating marketing practices that are either highly questionable or out‐and‐out unethical.

The book is no mere laundry list of complaints. Peterson concludes with an eloquent 20 page epilogue of practical policy recommendations. The points considered are substantial ones. These include the need to improve government oversight, collect better data on drug‐related deaths, and better inform patients on the real facts of a drug's efficacy. The truth is that health costs are rising because Americans are taking many more pharmaceutical medications that they have taken in the past, especially new and much more expensive ones. The side effects of some of these new drugs are less understood, and can lead to death or result in complications – even when taken exactly as prescribed.

In traditional business terms, pharmaceutical marketing has been highly successful in stimulating demand and thus expanding sales, utilizing promotions in novel and calculating ways. While this profit performance would be enviable in other industries, the stakes and consequences are radically different in this one. This book presents a sobering portrait of the pharmaceutical industry as a business that consumes increasingly larger portions of the gross domestic product of Americans, while offering less and less of value in return. There is a lot presented in these pages that the medical community needs to consider in improving healthcare systems globally.