NUCCA News - Who will take on the pushers?

By MARGARET WENTE

Thursday, December 19, 2002 – Page A23

Link: http://www.globeandmail.com/servlet/ArticleNews/PEstory/TGAM/20021219/COWENT19/Science/science/science_temp/2/2/3/

Every day, I have to take a fancy pill to get my blood pressure to behave. (I blame my genes, not my job.) The pill costs a dollar. Now it turns out that an older pill costing 10 cents would probably work just as well, or even better.

Hypertension, a fancy word for high blood pressure, affects one in four adults. So it's not surprising that the landmark study about cheap blood pressure pills made big headlines yesterday. If people switched their $1 or $2 pills for 10-cent ones, the savings will be in the billions. "This has enormous implications for the health-care system," says Frans Leenen, the lead Canadian researcher for the study.

It also has enormous implications for the drug industry, where blood pressures must be soaring. At stake is a market that amounts to $20-billion (U.S.) for hypertension drugs alone. The drug companies won't let their profits slip away without a fight.

"I think the drug companies will continue to persuade doctors to give us the $2 drug," says Marcia Angell. "They'll give them lots of free samples and lots of gifts and goodies."

Dr. Angell, who is former editor-in-chief of The New England Journal of Medicine, is a leading critic of the unholy alliance between the drug industry and the medical profession. The industry's first and foremost aim is not to sell the most effective treatments, but to market high-profit branded medications. And that has produced plenty of bad medicine along with the good.

"What this study underscores is the necessity of comparing new drugs with old drugs," says Dr. Angell. "But the Food and Drug Administration allows the drug companies to get away with comparing their new drugs with placebos."

Unlike most clinical trials, this one was funded largely by the National Institutes of Health, an independent U.S. government body. Independent research on this scale is rare because of the high costs. But independent research also tackles issues the industry never will. Drug companies have nothing to gain by finding out that their expensive pills can be replaced by cheap generics.

Dr. Angell lays out a brief against the industry in the current issue of The New Republic. "Far from being a 'research-based industry' as it likes to call itself, the pharmaceutical industry now devotes most of its resources to functioning as a vast marketing and advertising enterprise." This will hardly come as a surprise to anyone who's watched American TV lately. Those non-stop pitches for Celebrex, Vioxx and Viagra have turned them into billion-dollar gold mines.

The pharmaceutical industry argues that it needs high profits because it has to spend heavily on research and development to produce the next drug breakthroughs. But the pipeline of breakthrough drugs is drying up. And the industry has been switching more and more of its resources into marketing. Today, it spends far more on selling drugs than it does on developing them. "The R & D costs are nowhere near what they claim, and the innovation is nowhere near what they claim," says Dr. Angell. "So their two central arguments fall by the wayside."

Billions of that marketing money are aimed at buying the goodwill of doctors, the people who decide whether you need the $2 pill or the 10-cent one. For years, drug makers have showered doctors with free trips, meals, golf, drinks, skiing and other perks. Interested in an "educational seminar" about a new drug treatment? Just bring the family to Paris for free. Plenty of doctors see nothing wrong with this. In fact, drug representatives swap stories about the outrageous demands some doctors make just for giving them some face time.

"My criticism of doctors is stronger than my criticism of drug companies," says Dr. Angell. "The drug companies are going to do anything they can to make a profit. But the doctors are supposed to be unbiased and critical."

Big Pharma runs the richest lobby in the United States, which means that drug price and marketing reform will not be easy. But its days of calling the shots are on the wane. The reason is that its customers are choking on soaring costs. Drug costs are rising by more than 15 per cent a year. In Canada, we now spend as much on drugs as we do on doctors. Eventually, governments, managed-care plans, and big companies with expensive benefits plans will begin pushing back. They'll have no choice.

Will my doctor tell me to throw out my dollar-a-day pills? I guess I'll find out soon.

"The interesting thing will be the extent to which physicians will be following the evidence," says Dr. Leenen. "It's very unpredictable."

But one thing's not unpredictable at all. If they don't follow the evidence, sooner or later someone will make them.

mwente@globeandmail.ca