Book World: 'Our Daily Meds'

'How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs'

"Once upon a time there was an industry called pharma that was interested in doing well and doing good. Run by doctors and chemists, drug companies employed battalions of researchers whose scientific efforts resulted by mid-century in a flood of life-saving drugs, including antibiotics, vaccines, tranquilizers, antihistamines and steroids. As George Merck, president of the company founded by his father, put it in 1950, 'We try never to forget that medicine is for the people. It is not for the profits. The profits follow. . . .' And how. Today, of course, drug companies are hugely profitable enterprises and the darlings of both Wall Street and K Street, having spent more on lobbying than any other industry between 1998 and 2004."

Melody Petersen, author and former New York Times reporter, was online Tuesday, April 8 to discuss her new book, "Our Daily Meds," which was reviewed in Book World.

Petersen's book is an examination of the pharmaceutical industry, and its influence in our medical system.

Join Book World Live each Tuesday at 3 p.m. ET for a discussion based on a story or review in each Sunday's Book World section.

The transcript follows.

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Melody Petersen: Good afternoon, everyone. I'm delighted to be here to answer your questions on my book, Our Daily Meds.

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Baltimore, Md.: The problem with asking your doctor anything is that they are victims of pharmaceutical propaganda and falsification and data hiding, too. Plus, most doctors who set standards for things like cholesterol levels are linked to industry.

How will any of us find out who should take cholesterol-lowering drugs are needed, or what the goal should be?

Melody Petersen: You've hit on one of the most frightening parts of my book. Doctors are learning that they can't trust what they read in their medical journals anymore. The drug industry pays for almost all clinical trials of their medicines. And it is clear the companies know how to design these trials to generate data that will best sell their products. There has been case after case where a company has been found to manipulate a study so that a new drug appears to be more effective or safer than it actually is. This is a very serious problem that I don't think the public yet understands.

The industry has also hired most of our best academic minds to work as their consultants or advisors, leaving few independent scientists to point out the flaws in the studies and help protect the public. We desperately need to change this situation.

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Alexandria, Virginia: My ex-husband works for Pfizer in Public Relations, but while we were still married, I was privy to information that Pfizer had to cover up, naturally. That knowledge began a cautionary approach for me in terms of synthetic drugs and medical equipment, not to mention synthetic drug-pushing doctors.

Why can't we take back our lives from Big Pharma? Yes, Wall Street and K Street keep us constrained, but if we do not reinvent our health care system, including the stranglehold Big Pharma has placed on us, we are all doomed.

Melody Petersen: You saw this from the inside. I decided to write the book so that people would understand what is going on inside the big drug companies and realize just how careful they need to be with these medicines.

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Baltimore, MD: Ms. Petersen,

I have read that a large number, even a majority of new drugs were developed at either universities (drug companies contribute but still heavily supported by the public) or Federally funded Labs (NIH), and that drug companies spend far more on their advertising budgets than they do on their R&D budgets - if these claims are valid, how does this square with the pharmaceutical industries claim that drug costs are 'mostly' driven by the R&D costs?

A recent example would be the new, natural sweetener (D-Tagatose) that was sold for years at the 7-11 for diet sodas and later discovered that it lowers blood sugar (already approved for this use by the FDA in 2003) for type II diabetics but a drug company will now 'spend' millions checking if it is safe and effective to use! Looks like a crock just to charge a fortune for a very well understood known that use to be available cheaply.

Melody Petersen: You're right. The majority of our best medicines were invented not by the industry but by scientists working on grants provided by taxpayers. A Congressional report in 2000 found that 15 or 21 of the most important drugs discovered between 1965 and 1992 were developed from federal research. The industry doesn't want the public to understand this.

It also does not disclose how much it actually spends on promotion or research. The companies want us to believe that most of what they do is research and that this is why medicines cost so much. But it's clear the big drug companies spend far more on promotion than science. Executives at AstraZeneca have noted that a company must spend as much as $1 billion on promotion by the end of the drug's second year on the market if they want it to become a top-selling drug like Nexium, the company's heartburn drug.

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Philadelphia: Aren't doctors integral in the way the pharma industry has changed? If a patient requests a drug as a result of heavy marketing, doesn't the doctor have the right to say no? To not prescribe an inappropriate drug?

Melody Petersen: Doctors do have the right to say no. But more often than not, doctors prescribe the drug patients ask for. Sometimes they write the prescription even if patients don't have the disease. For example, in one study, more than 50 percent of patients who asked for a prescription of Paxil, the antidepressant, received it even though their symptoms did not meet the symptoms of depression. This is happening because most of the drug companies' marketing dollars goes to our physicians.

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Washington, D.C.: Are there certain kinds of drugs that raise more concern from what you have seen? I am thinking of headlines we have seen recently about painkillers, heart medications, hormone replacements... or is this happening all across the industry with all kinds of medications?

Melody Petersen: These are not just isolated cases that we read about in the news. All of these disasters - where we learn that a medicine used by millions of people has hidden side effects - have a common thread. And that is the industry's aggressive marketing tactics. It's not a few rogue companies causing these problems, but standard marketing tactics used by all the big drug companies. Unfortunately, we will continue to see these tragic cases until something is done to reign in the industry's promotion.

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please explain:"most of the drug companies' marketing dollars goes to our physicians."

Melody Petersen: When people think of the promotion of prescription drugs, they think of all those ads on TV. But actually most of the companies' promotion is aimed at physicians. The drug companies now pay for as much as 80 percent of the continuing medical education doctors receive after medical school. At the same time, the companies give doctors gifts and cash. The physicians writing the most prescriptions often get the most freebies. The companies hire doctors to be their "consultants" and "advisors." A recent survey of physicians found that 94 percent of them had received cash or something of value from the industry. Some doctors take hundreds of thousands of dollars a year from the drug companies.

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Reston, Va.: As director of the National Physicians Alliance, a new multi-specialty medical organization that accepts no money from pharmaceutical companies, I am particularly concerned about industry efforts to package marketing materials as "physician education" and to portray sales representatives as "educators." The NPA has just launched a campaign encouraging doctors to limit their interactions with the marketers, and our Unbranded Doctor resources are available at http://unbrandeddoctor.org/

Melody Petersen: This is so wonderful to hear about. The public desperately needs the help of organizations like yours.

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Munich, Germany: With all the variations of particular medications available from different manufacturers, I'm surprised that competition hasn't driven prices much lower than they are.

The review of your book states, "But no company can abandon its marketing strategy and put its money back into research without jeopardizing the sales of its current drugs". It's as if pharmaceutical companies are so driven by short term goals that are collectively walking the gang-plank into the ocean. This industry-wide behavior is puzzling, don't you think?

Melody Petersen: Good question. It's not so puzzling when you understand just how much money can be made by introducing a medicine that is little different from a blockbuster product already being sold by your competitor. Here, in the U.S. drug companies can charge whatever they want. We're the only developed country in the world that has no controls on drug prices. This shows you the power the drug industry has in Washington.

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Southern Maryland: I think I am the rare 47 year old woman that doesn't take any OTC meds or Rx. Medical professionals always say "You don't take ANY medications?" No high blood pressure, normal HDL and LDL, blood sugar is fine, etc. I do exercise faithfully, eat a high fiber diet, eat my leafy greens and fruit, and read health magazines. I am working on getting rid of 30 extra pounds. I can understand how people get pressured to try Rx and OTC meds with the heavy ad pressure. When you feel bad some pill has to work cause everybody says so. "Take something for it." The only thing is that the real problem is that Americans are too sedentary with high fat diets. When I saw folks who had DOGS with weight problems and DIET dog food, good grief, we have turned into a nation of medicated and overweight citizens and PETS!!

Melody Petersen: I commend you for your wise approach to health. As I write in my book, many doctors don't take the time to tell their patients about the extraordinary benefits of exercise and maintaining a healthy weight. It is much faster to write a prescription, which is just as the industry has trained them to do.

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washingtonpost.com: Melody, I understand your interest in the pharmaceutical industry began when you reported on the field for the NY Times. Tell us a little about your initial reporting and how it led you to write a whole book.

Melody Petersen: As a reporter, I was constantly amazed and disturbed about all the promotion the drug companies did from behind the scenes. For example, if they need a group of patients to stand up and be advocates for their drug, some companies have simply created a group that looks like a cancer society. It might look like an independent group formed to help patients but it is really the creation of a public relations firm working for a drug company. I wanted to write the book, in part, so that the public would be able to see through these dangerous tactics.

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Olympia, Wash.: After I read about your book in The New York Times, I decided to do a series on prescription drugs for my blog The Survive and Thrive Boomer Guide at http://boomersurvive-thriveguide.typepad.com/.

I was stunned by what I found out: increasing injuries and death from prescription drugs; weakening of enforcement by FDA; increasing irresponsibility of the pharmaceutical industry in promoting and advertising; and growing numbers of people taking more and more drugs.

The situation seems out of control. What can consumers do about it?

Rita, Consumer Specialist

Melody Petersen: We all need to be extremely careful. After talking to doctors and doing research on this for eight years, I think one of the most important bits of advice is to make sure you don't take a drug you don't need. All drugs have risks. When you take a drug you don't need, you can't benefit from it, you can only be harmed.

Also, find a good doctor who is fed-up with all the industry's promotion and wants to do what is right. If you're sitting in a waiting room and see sales reps bringing lunch for the doctor's staff, that's a sign you may want to find another doctor. If you really like your doctor, tell him or her this really bothers you. If they are as good as you think, they will change their ways.

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Melody Petersen: Our time is up. Thank you so much for all the questions. I'm sorry I didn't have time to get to them all. As you can see, the aggressive promotion of prescription drugs is something that impacts everyone. So much needs to be done. I hope you will read my book. I think it will open your eyes to what is going on.

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