Prescription for disaster: drugs, lies, and greed

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Prescription for disaster: drugs, lies, and greed

By Ellen Ruppel Shell | June 8, 2008

Our Daily Meds: How the Pharmaceutical Companies Transformed

Themselves Into Slick Marketing Machines and Hooked the Nation on

Prescription Drugs By Melody sen.

Farrar, Straus & Giroux, 432 pp., $26

In mid-January, Merck and Schering-Plough announced that their

cholesterol-lowering drugs Zetia and Vytorin, taken by 5 million

people, may in fact increase the risk of heart attacks by encouraging

the buildup of arterial plaque. Outraged critics accused the companies

of delaying the release of a key study, a charge made compelling by

the fact that sales of the two drugs were $5 billion in 2007, a full

year after the study was completed.

After the news hit, Merck and Schering-Plough stock prices spiraled

down. The House Subcommittee on Oversight and Investigations planned

an inquiry. But Merck chief executive stood firm, saying

he stood by the safety and efficacy of the " products, " both of which

remain on the market.

Between 1980 and 2003, the amount Americans spent on prescription

drugs quietly rose from $12 billion to $197 billion, a seventeenfold

increase. But what all this spending has done for us is not entirely

clear. A World Health Organization report released a few years ago put

American longevity at 77.3 years, Canada's at 79.8, and Japan's at

81.9. Meanwhile, we spend substantially more on health care - and far

more on drugs - than these and other longer-living nations.

As Melody sen points out in " Our Daily Meds, " a sobering,

scrupulously researched polemic, medicines not only cost a bundle,

they save far fewer lives than we think - in fact, it is estimated

that one American dies every five minutes from a prescribed treatment.

Doctors, she reports, are complicit in these deaths, as fully 95

percent take money from the drug industry.

sen illustrates this with a series of case studies, the most

horrifying of which follows the exploits of lin, a

scientist turned drug salesman. lin's job was to increase sales

of Neurontin, a drug approved to treat epilepsy in limited cases. (In

5 to 10 percent of patients, the drug actually worsened the illness.)

Company executives, not satisfied with selling Neurontin for its

limited approved use, marketed it for a dozen other, unrelated

conditions for which it had not been tested, among them attention

deficit disorder, sexual dysfunction, manic depression, and -

bizarrely - chronic hiccups. To that end, the company paid legions of

doctors to promote the drug through lectures, testimonials, and faked

reports in scholarly journals. Doctors were handed tens of millions of

dollars in cash, and showered with lavish dinners and " educational "

junkets.

Soon the FDA was flooded with complaints of side effects, ranging from

hallucinations and extreme fatigue to sudden death. Still, nothing was

done until lin blew the whistle. Concluded a physician at the

National Institute of Mental Health after taking a close look at the

drug, " Neurontin is being used like water for disorders where there is

not much evidence it is effective. Nobody even knows how it works. "

In May 2004, Warner-Lambert pleaded guilty to criminal charges and

agreed to pay $430 million in restitution, yet this was only a

fraction of the profits the company made - and continued to make - on

Neurontin. Given this lack of disincentive, it's no wonder that

nefarious drug-company marketing practices continue to proliferate and

do harm.

Though other authors have made similar charges, sen's well-honed

reporting skills enable her to build an extraordinarily persuasive

argument, methodically laying out case after case of greed, graft, and

misconduct chilling in their details.

sen's scrupulousness as a reporter, however, is also her

limitation, for while the evidence is carefully gathered and the

stories dutifully told, neither analysis nor narrative is a strong

suit here. Parts of the book - such as a section on antibiotic

resistance - seem dated, and even naïve, while others, like a section

on prescription drug pollution, seem hasty and thin. But the book's

strengths as an exposé of a national crisis far exceed these

weaknesses. And the author's prescriptions for change are astute.

sen calls for a strengthening of the FDA, along with a renewed

emphasis on preventative health to reduce the need for drugs. She

argues sensibly that patients be told the whole truth about every drug

they are prescribed, including its efficacy and its side effects. More

boldly, she calls for a legal ban on doctors consulting for or taking

money or gifts from any medical company, and another prohibiting the

companies from offering them. Failing this, she makes the provocative

case that doctors be required to present each patient with a list of

his or her drug-company sponsors, complete with the cash value of each

gift.

" Our Daily Meds " is a well-argued and important reminder that as a

nation we need to work harder to wrench back a health-care system from

the unfettered greed into which it continues to sink. Given the rising

cost of care and the growing demand for it, we have no choice but to

take careful heed.

Ellen Ruppel Shell, a professor of journalism at Boston University and

author of " The Hungry Gene: The Inside Story of the Obesity Industry, "

is currently writing a book on the science and politics of low price

in America.

http://www.boston.com/ae/books/articles/2008/06/08/prescription_for_disaster_dru\

gs_lies_and_greed/