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Medicine

Why do Americans take so many pills? It may have more to do with business than science.

By David Tuller
Sunday, October 10, 2004; Page BW04

Do others besides me have the nagging sense that way too many people are consuming way too many pills these days? It's impossible to turn around anymore without being bombarded by ads, news reports and anecdotal accounts from friends and relatives about how this or that blockbuster pharmaceutical -- Viagra or Paxil or, at least until it was yanked off the market last month for raising cardiovascular risks, the anti-arthritis drug Vioxx -- has the power to lift every burden from our sad, diminished lives.

No one could dispute that the 20th century witnessed the arrival of numerous medical compounds with astonishing properties: antibiotics, painkillers, AIDS drugs, and the list could go on and on. If it seems these days that new miracle drugs are being marketed for every conceivable complaint, three new books help to explain why. And even as they enlighten, they offer an unexpected but enormous pleasure: a front-row seat to the smacking-down of the pharmaceutical industry for its excessive zeal in promoting its wares.


The anti-arthritis drug Vioxx was recently taken off the market. (Ap)

Take, for example, the recent revelation that unpublished clinical trial data suggest that some of the most highly touted antidepressants might actually increase suicidal behavior among teenagers. Is anyone really shocked that a mega-billion-dollar industry might be less than forthright when its products fail to perform as promised? If so, this trio of volumes detailing drug companies' aggressive and often sleazy marketing tactics will provide a bracing dose of reality.

Alone, each book presents a compelling case; as a group, they deliver a pretty hard blow to the industry's "we're-here-because-we-care-about-you" posturing. It's certainly possible to believe in the importance and value of many modern pharmaceutical products and still be disheartened -- or worse -- by the skillful ways the industry exploits consumers' hopes and blurs the critical distinction between help and hype. None of these books is perfect, but each has its virtues.

A Marketing Juggernaut

The Truth About the Drug Companies: How They Deceive Us and What To Do About It (Random House, $24.95), by Marcia Angell, a former editor-in-chief of the New England Journal of Medicine, provides the broadest overview and the most thorough context. Her voice is always authoritative, sometimes testy and often brimming with anger and frustration at what she views as drug-company shenanigans.

Most of what she covers here -- the pharmaceutical industry's frightening grip on research, medical education and government policy -- has been reported before in both the mainstream press and professional publications. But she braids all the strands together and delivers the message -- that drug-company money and power is corrupting American medicine -- in a convincing, no-nonsense manner.

While drug companies complain about their costs, Angell reports, they enjoy a profit margin five times that of other Fortune 500 companies; moreover, most of their new products in recent years have not been major advances in treatment but "me-too" drugs designed to snatch sales from their competitors. And, she notes, with their extensive financial ties to the doctors and scientists who research and prescribe their drugs, their platoon of lobbyists in Washington and their eagerness to sponsor supposedly objective seminars and symposia for physicians, they have established a dominant influence over what ends up happening in intimate decisions between doctors and patients. Angell writes: "Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the Food and Drug Administration, academic medical centers, and the medical profession itself."

Viagra Falls

That marketing juggernaut is on full display in Meika Loe's The Rise of Viagra: How the Little Blue Pill Changed Sex in America (New York Univ., $27.95). Loe, a sociology and women's studies professor at Colgate University, details how the pharmaceutical industry has deployed flawed statistics to push the conceit that 30 million American men -- including more than half of all men over 40 -- need medication to have decent sex. But that estimate was derived, she points out, from a study that slyly managed to broaden the definition of "erectile dysfunction" to include the experiences of many older men who were simply aging normally. "Apparently," Loe writes, "erectile dysfunction, while appearing to be a precise, objective measure, is flexible and subjective enough to include almost any male with sexual insecurities, dissatisfaction, concerns, or intermittent erectile 'failures.' "

Loe's writing can be clunky, and the book suffers at times from excessive doses of academic language. Still, she delivers a smart, pointed analysis of the drug companies' phenomenally successful efforts to promote their goodies by underwriting professional gatherings, plying leading urologists with consulting fees and research grants, and hiring well-known athletes to pitch the drugs to consumers worried about not measuring up. And now, she reports ominously, the pharmaceutical companies hope to repeat that success by finding "cures" for the sexual problems that -- according to industry-funded scientists -- afflict almost half of all American women.

Cooking the Books

John Abramson, a clinical instructor at Harvard Medical School and the author of Overdosed America: The Broken Promise of American Medicine (HarperCollins, $24.95), has done what most physicians don't have the time or inclination to do: He's not only read the peer-reviewed articles upon which doctors base their prescribing habits but also has examined the actual study data for some of today's most popular drugs. As a primary care doctor in Massachusetts, he constantly found himself on the receiving end of drug-company pitches. And, he writes, he believed in the integrity of the medical information system -- until he sat down and examined the clinical trial results in detail.

The strength of Overdosed America is in these close readings of the research. Abramson walks the reader through the contradictions he's discovered between the exorbitant claims made for the products and the actual study data -- or between the data and the subsequent medical guidelines promulgated by government-sponsored panels, whose members, he reports, often have financial ties to the companies that make the drugs they're recommending.

Abramson argues, for example, that the benefits of the cholesterol-lowering drugs called statins are nowhere near as great as generally believed, and certainly do not approach the advantages conferred by lifestyle changes that would cost much less. Reviewing studies of the blockbuster anti-arthritis drugs Celebrex and Vioxx conducted years before the recent announcement of Vioxx's dangers, he reports that the two medications, although marketed as safer than an earlier and cheaper generation of products, can actually cause more severe side effects. And he recounts the now-famous story of how drug companies and doctors persuaded millions of menopausal women to go on hormone replacement therapy, which later proved to significantly increase the chances of suffering from breast cancer and heart attacks.

In one particularly enlightening section, Abramson analyzes various methods drug companies use to massage their research data and obtain the results they'd like. "Rigging medical studies, misrepresenting research results published in even the most influential medical journals, and withholding the findings of whole studies that don't come out in a sponsor's favor," he writes, "have all become the accepted norm in commercially sponsored medical research."

Beyond Abramson's focus on the details of medical studies, he covers much the same ground that Angell does, although not quite as comprehensively. Both authors offer a list of suggestions -- some practical, others probably wishful thinking -- for reducing the drug companies' influence. But these ideas remain overshadowed by the much larger and more compelling point: If this is the industry we hope will rescue us from disease, pain and unhappiness, we're in real trouble. •

David Tuller is a contributing writer at Salon.com.


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