Saturday, May 31, 2008

Melody Petersen's OUR DAILY MEDS: Scary Things

In writing HOOKED, I relied very heavily on a series of excellent articles that investigative reporter Melody Petersen wrote for the New York Times between 2000 and 2004. Petersen then sort of dropped out of sight. Apparently this book was the fruit of her interim labors.

The first two-thirds of the book will be pretty much old news to regular readers of this blog. It rehearses how aggressive marketing replaced the discovery of new and useful drugs as the pharmaceutical industry's main line of work, and how all too many physicians were all too happy to acquiesce in the process so long as their pockets, or stomachs, were well lined. In other words, what has already been written about pretty thoroughly in recent books--even if Petersen was the first to report on some of these events in the NYT.

Things get more interesting in the final third of the book. Petersen starts to detail a list of more distant ripples of the overmarketing of pharmaceuticals--like how many different drugs can now be found in the US water supply; how many deaths per year from auto accidents were actually caused by drivers zoned out on prescription drugs; how little we know about how many deaths per year are actually due to prescription drugs; how readily grade school and high school kids now trade each others' prescription drugs back and forth even as illegal street drugs are going out of fashion among them.

I can probably best give the flavor the the book by summarizing the list of recommendations Petersen makes at the very end:
  • Redesign the standard death certificate to make it easier to record prescription drug use as a contributing cause of death. Do many more autopsies to be sure we know what really has caused deaths.
  • Outlaw physicians taking any money from the pharmaceutical industry. (If we can outlaw DJs taking money from record companies, says Petersen, why not?)
  • Create an NIH-type agency to oversee pharmaceutical research and assure scientific integrity of results.
  • Assure that patients receive the full information about drugs, in readily understandable form, before they are prescribed. (Petersen is sure that if patients knew how poorly many heavily advertised drugs really work, they'd refuse many of them.)
  • Repeal FDA drug company user fees and generally stiffen the agency's spine to regulate the industry.
  • Stop covert drug marketing through celebrity endorsements, ads masquerading as news on local TV, health fairs and screening secretly funded by industry, and industry largesse to non-profit patient advocacy groups without disclosure.
  • Do more testing of drivers who cause accidents for prescription drugs and require clear warning symbols on labels of drugs where driving is warned against. Punish docs who fail to warn their patients that they should not drive when taking a drug.
  • Throw executives in jail if the company commits fraud--forget the "big" fines that companies now regard as a simple business expense.
  • Focus more effort on prevention and less on taking pills after you get sick.
One final irony--Petersen has a chapter on the outrageous prices drug companies now charge for sopme drugs, especially those for cancer treatment. One example she gives is an Iowa woman who complained when a single prescription for Thalomid, the medicine that she takes for her multiple myeloma, cost $5000. Petersen neglects to explain what Thalomid is. In the old days, it was known by its generic name, thalidomide. Yes, it's the same drug that caused the horrendous birth defects back in the early 1960s and led to the Kefauver-Harris amendments of 1962 that gave the FDA broad new powers to requre evidence of efficacy as well as safety of drugs. After years of no one being willing to touch that drug with a ten foot pole, it has found new life for limited uses like multiple myeloma. But the very idea that this drug, which is older than dirt and pretty easy to manufacture, should be priced at $5000 a presciption beggars belief.


Anonymous said...

Dr. Brody,

With all due respect, you should consider not criticizing similar books to the one you composed. Ms. Peterson is a very well known lady from the NYT and her book was just as informative as yours, in my opinion.

Unknown said...

Just a quick clarification: the company that markets thalidomide for cancer had to prove that it was useful in clinical trials, so there was some additional R&D costs in bringing this drug to market in its latest incarnation. Not that it justifies its $5000 pricetag. The current pricing of cancer therapeutics is a national scandal, especially given their limited utility. But oncologists, who get a six percent markup on the price of the drugs, have a vested interest in getting them on approved compendia, even when they are not FDA approved uses. And industry-funded docs dominate the committees that wrote the latest compendia added to the CMS (NCCN's). And CMS, like most insurers, are loath to tell dying cancer patients they won't pay for what their oncologists prescribe. So, voila!, $5000-$10,000 a month cancer drugs.

Anonymous said...

Which is worse, a $5000 medicine or a medicine that does not exist? Why is it a drug company's responsibility to give their medicine away for doing us the service of developing it? Maybe you can start attacking companies before they even put a medicine on the market then no one will have to pay outrageous prices for their drugs! A funny thing comes to mind after reading your wonderful blog...It's surprising that you have the resources to own a computer and maintain blog since you must give all your work away for free -- the correct thing to do for 'society', of course.