Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs
By Melody Petersen
Farrar, Straus and Giroux, 2008
Review by Katherine Czapp
One way to assess the current state of health care in the United States is to look back just a couple of decades to world longevity statistics. A sixty-five-year-old American woman in 1980 could expect to enjoy a longer life span than could her contemporary in most other places in the world. By 2002, however, a sixty-five-year-old woman, with access to the nearly unlimited supply of the newest and most expensive drugs the American pharmaceutical industry has to offer, had slipped from her comfortable spot in expected life expectancy. Among longevity spans determined for thirty countries in that year, the American woman would come in seventeenth. American men have fared even worse, and a sixty-five-year-old American man today can expect a shorter life than a man his age in Mexico.
Melody Petersen presents these statistics in Our Daily Meds as one means of examining the purported value of the flood of prescription medicines engulfing the American public. No one can seem to account for the dismal showing of Americans in international longevity comparisons, she points out, even though the United States spends more per person on medical care than any other nation on earth. How much more? More than do all the people of Japan, Germany, France, Italy, Spain, the United Kingdom, Australia, New Zealand, Canada, Mexico, Brazil and Argentina combined. In 2005, that was an average of $6,700 for each person per year; $26,800 for a household of four. More money than was spent on housing, food, transportation, or anything else.
Petersen pounds home the personal, individual cost of medical care because once she begins to report on the profits of the pharmaceuti cal industry, the numbers soon reach proportions that can no longer easily be held in one’s head. In 1980, Americans spent $12 billion on prescription drugs. By 2003, that figure had risen to $197 billion. In the same time period Americans had doubled what they paid for cars, and tripled what they paid for clothing, but their spending on pharmaceuticals had increased seventeen times. Then there is another personal cost paid every day by Americans who are the customers of the pharmaceutical industry. In 2006, according to Petersen, the average American collected twelve prescriptions; the average senior citizen took home more than thirty. And today nearly 65 percent of the entire American population daily takes at least one prescription medication.“There is a problem, however,” Petersen goes on, “. . . one that the drug companies and doctors prescribing the medicines do not like to talk about. Experts estimate that more than one hundred thousand Americans die each year not from illness but from their prescription drugs. Those deaths, occurring quietly, almost without notice in hospitals, emergency rooms, and homes, make medicines one of the leading causes of death in the United States. . . . Prescription medicines, taken according to doctors’ instructions, kill more Americans than either diabetes or Alzheimer’s disease.” On a daily basis that is two-hundred-seventy people – one every five minutes – killed by prescription drugs.
Could these deaths and serious injuries possibly be one reason the nation’s longevity ranking has plummeted?
Hand in hand with these dismal facts of death and destruction wreaked by prescription drugs comes what is really a macabre American success story. All that aggressive marketing works, for which Petersen repeatedly offers proof. “America,” she says, “has become the world’s greatest medicine show.” And the drug merchants have become America’s most powerful industry.
In the section “The Rise of the Medicine Merchants,” Petersen reports on the utter triumph of corporate salesmanship and profit-driven marketing strategies of the largest pharmaceutical companies over science, the practice of medicine, and even the American way of life.
Drug marketers pitch their wares to the public via every means available and in every niche into which they can insinuate themselves, such as state fairs, shopping malls, churches, NASCAR races, on television, billboards, scoreboards, and through nonprofit foundations whose “outreach” activities are funded by the drug companies.
For example, doctors in Iowa sometimes referred young patients to a nonprofit group called the Magic Foundation, organized by mothers with children with rare growth disorders. As Petersen reports, “Over the years, the foundation had accepted thousands of dollars from the companies selling prescription growth hormone products. In a campaign in the early 1990s, the Magic Foundation, as well as another group, the Human Growth Foundation, had measured the height of children in public schools. The screeners suggested that the shortest children visit their doctors for medical treatment. Most of the schools and the parents did not learn that the two foundations had received most of their funding for the school screenings from Genentech and another hormone manufacturer. . .
“The Magic Foundation. . . continued to recommend hormone injections to short children and their parents and describe the drugs in ways the manufacturers could not do without breaking the law. A story published in the foundation’s glossy magazine that I picked up at a pediatricians’ conference in 2005 was entitled, ‘Me and My Growth Hormone.’ The story began, ‘I was short. My little sister was taller than me. Kids at school picked on me and called me names.’ The tale continued with the child getting growth hormone injections and growing so much his pants got too short. ‘I’m almost grown now,’ the story ended. ‘I’m in the normal range on a growth chart. Growth hormone is like a miracle drug.’”
It might come as a surprise that even though drug advertising is everywhere and directed at everyone from young children to their grandparents, the vast majority of the industry’s marketing dollars is actually reserved for physicians. Cynically viewed as the trusted “gateway” to new customers, physicians are aggressively and lavishly courted by drug company sales reps. According to Petersen, “In 2004 the industry employed an army of 101,000 sales representatives to call on those doctors—two and a half times the size of its sales force in 1995. There is now one drug salesperson for every six physicians, each with an expense account that lets him or her shower doctors with gifts and cash. Surveys show that virtually every American physician now takes these handouts.” In return, of course, the doctors are expected to provide “scripts” (that is, more customers) and most do.
Since only about ten percent of the sticker price of most brand name prescriptions is needed to cover raw materials and manufacturing costs, the industry is rolling in dough while taxpayers are emptying their pockets. “With their hoards of cash,” writes Petersen, “the companies have readily handed money to patient groups, hospitals, universities, medical schools, physician societies, government agencies, and just about any organization they want on their side. Harvard, for one, has a lecture hall named for Pfizer in a building named for Mallinckrodt, another company.” Industry money influences academia, and what new “blockbuster” drugs will receive money for research. Whether this new drug will help or harm people is not important as long as it will increase profits for company shareholders.
Are there no checks and balances? What about the Food and Drug Administration, or Congress? “The drug companies’ chain of influence is so complete that there are few people left to look objectively at the effects of their products on the nation’s health or at the consequences of their power for society. . . . Washington is the axis of the industry’s power. The pharmaceutical companies spent more on lobbying between 1998 and 2004 than any other industry. By 2004 the companies employed a legion of lobbyists so large that there were more than two for each member of Congress. By using their wealth to buy influence, the drug companies have repeat edly squelched attempts to regulate their prices and promotional practices.”
The pharmaceutical industry has won other laws that allow companies to profit from research and medical discoveries made by taxpayerfunded scientists; to prolong patent protection periods by years; and to win lucrative tax credits which have allowed them to pay far lower taxes than other industry groups.
Petersen’s disclosure of facts alongside numerous human interest stories are a compelling moral indictment of a corrupt and corrupting “industry.” One can even marvel at the lunacy it has created in our medical system: “There is a kind of madness in it. The drug companies pay hundreds of millions of dollars in government fines for promoting their products illegally and hundreds of millions of dollars more to the families of the victims who suffered or died, then raise their prices and promote their products even harder.”
Marketing has no place in medicine, Petersen says flat out. She calls for science to become honest again, for physicians to stop taking drug company money, for marketing fraud to be stopped, for patients to arm themselves with knowledge and independent thinking, and for a revolution to start among citizens at the grassroots who will elect officials to defend them and their rights.
She even questions the belief that we need so many pills to be healthy, and wonders whether disease prevention might not be a better route. While all of her recommendations are noble, no one can deny that their realization is a long way off; in the meantime her book serves to educate and sound a moral alarm. Following Our Daily Meds with Fight for Your Health: Exposing the FDA’s Betrayal of America by Byron Richards will complete the picture of corruption in the American medical system as well as bolster those who understand that taking full responsibility for one’s health is always the best path.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Summer 2009.