Big Pharma’s Sneaky Cash-Churning Schemes

Dangerous drugs

By Martha Rosenberg.

If you are like most people, you have been watching “Ask Your Doctor” drug ads on television for years. The ads, called direct-to-consumer drug advertising, have done two amazing things. They made drugs like Claritin, Lipitor and the "Purple Pill" financial blockbusters -- and they have, to a certain extent, "sold" the conditions behind them.

While certainly the conditions the drugs treat like seasonal allergies, GERD, high cholesterol, depression, bipolar disorder, adult ADHD, erectile dysfunction, Low T, irritable bowel syndrome, dry eye and insomnia exist, "awareness" of the conditions has greatly increased thanks to drug ads. In fact the parade of symptoms viewers may suffer from has gotten so over the top, comedian Chris Rock said he was ready to hear a TV ad asking, "Do you fall asleep at night and wake up in the morning? You may be suffering from ... "

For many years, consumer drug advertising made Big Pharma Fortune 500's "most profitable industry." But now, the profit party is largely over, with blockbusters like Prozac, Lipitor, Viagra, Zyprexa, Symbicort and Nexium off patent and nothing much in the pipelines. WebMD, one of the strongest online pill merchandisers, dismissed 250 employees a year and a half ago, and medical journals are noticeably page light with fewer ads. Once booming companies are now seeking mergers commensurate with the Wall Street aphorism that in boom times companies spin off and in bust times they merge.

Four years ago Pfizer merged with Wyeth, Merck merged with Schering-Plough, and Roche merged with Genentech. Now Novartis, GlaxoSmithKline, and Eli Lilly are pursuing protective financial partnerships as the day of the drug blockbuster is over.

Still, there are three diseases and conditions that Pharma is hoping may see it through the current lean times.

Ankylosing spondylitis

If you look at the successful diseases Pharma has marketed to sell drugs, you'll see they usually have snappy names or initials like ED, ADHD, RLS, GERD, IBS and Low T. That's why a disease Pharma is pushing, ankylosing spondylitis, is gaining the nickname “AS.” Ankylosing spondylitis is a real and serious inflammatory disease that affects the bones and joints. New ads seek to convince people with back pain that their pain isn't from overexertion or a bad bed, but ... from AS.

This is what critics of Big Pharma call "disease mongering." Over the years, disease mongering convinced so many people they had "depression" it is said that one in four women between 50 and 64 in California is now on antidepressants.

Like "Are You Depressed" quizzes, AS ads come with a helpful questionnaire to convince people and hopefully their doctors that that they might suffer from AS. If so, they may just need to take Humira, a genetically-modified, injected drug that costs $15,000 to $20,000 a year per patient. Ka-ching. Drugs like Humira are "monoclonal antibodies" that suppress the body's immune system by blocking tumor necrosis factor (TNF). They are valuable for serious autoimmune diseases but increasingly marketed for less serious conditions.

For example, unless you really have to, who wants to take a drug whose label warns that "Patients treated with HUMIRA are at increased risk for developing serious infections that may lead to hospitalization or death?" These include "Invasive fungal infections, including histoplasmosis, coccidioidomycosi," and "Bacterial, viral and other infections due to opportunistic pathogens, including Legionella and Listeria?"

Non-24 hour sleep wake disorder

"You can't see me because of radio, and I can't see you because I'm totally blind." So begins a high saturation ad campaign that boosts "awareness" of an obscure circadian rhythm disorder called Non- 24 Hour Sleep Wake Disorder -- launched by Big Pharma. How rare is Non-24? There are only 146 citations for the disorder in the entire U.S. National Library of Medicine. By comparison, there are 8,463 citations for the plague.

The narrator of the drug ads says his blindness doesn't "hold me back" but he often "struggles to keep up" because he is not "sleeping through the night." He then says, "Sound familiar? You're not alone!" - You might have this too! The ads are from the Washington, DC-based drug company Vanda whose drug Hetlioz recently received FDA approval for Non-24 Sleep Wake Disorder.

When I called the phone number for more information about Non-24 I asked my "health educator" if I could have the sleeping disorder even though I am not blind. I was told, "You don't have to be blind to have Non-24," though it is more common in blind people. When I asked if there were a pill I could take, my educator said he was unable to answer that because, "I am not a doctor," but promised to send me more information.

On the Non-24 website which asks, "Could You Have Non-24?" we learn: "The key symptoms ofNon-24 are the inability to sleep or stay asleep and a powerful urge to sleep during the day." Other symptoms include waking up "groggy," being "less productive than usual at work or at school," relationships that "are strained," "sluggishness and forgetfulness," mood that is "affected" and frustration "because no one seems to understand what you're going through."

Clearly Non-24 Sleep Wake Disorder sounds like another disease Pharma has marketed - adult ADHD. Is it really possible to convince people who didn't get enough sleep last night and need to drink a cup of coffee (and go to bed earlier tonight) they have Non-24? Yes, because advertising works.

Suicide caused by black box warnings

Imagine blaming U.S. obesity on a "deficiency" of the diet drugs Meridia and Fen-Phen which were withdrawn because of their dangers. Ever since SSRI antidepressants received "black box" warnings for their suicide risk in young adults which cut into profits, Big Pharma has tried to blame rising suicide rates on a "deficiency" of SSRI antidepressants. Even though the reason they received FDA black boxes is because they are known to cause suicide.

The 180-degree chutzpah was spearheaded by Charles Nemeroff, MD who said in 2008,"The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates." Such warnings "unnecessarily frighten families away from seeking treatment," he warned. Nemeroff was investigated by Congress for undeclared Pharma income and admits to at least nine Pharma financial links.

The warnings were a "barrier" to treatment, agreed David Shern, PhD, president of Mental Health America in 2008, a group that was also investigated by Congress for its industry funding.

Even the New York Times carried the initial story about people dying from antidepressant deficiencies - until it was found to be inaccurate. While the statistics of rising suicides were correct, the drop in SSRI prescriptions that "caused" them had occurred the following year and the number of prescriptions in the cited year showed no change. Oops.

According to journalist Alison Bass, the paper on which the Times article was based was funded by a $30,000 Pfizer grant. An article by the same author in the British Medical Journal, who had financial links to Wyeth and Pfizer, attributed veterans' suicides to SSRI deficiencies. What?

The fact is the Iraq and Afghanistan wars were a cash cow to Big Pharma with one in six troops on its drugs. A veritable pharmaco-battlefield was created with troops marching on SSRis, benzos like Xanax, anti-seizure drugs, anti-psychotics, pain pills and sleeping pills and receiving more of the same for PTSD. Prescriptions for Seroquel (an anti-psychotic which also has a black box warning) went up 700 percent and the SSRI antidepressant Paxil was the drug of choice during in the Iraq war.

The military press itself reported on the overmedication and likelihood it was correlated with suicide. Military Times observed that the graphs of increased suicides in the military and increased drug prescriptions would fit exactly over each other. No wars before the Iraq and Afghanistan wars lost more troops to suicide than to combat - probably because the wars occurred before SSRis.

It is often said that the presiding precept in medicine should be "first do no harm." The warning certainly applies to Pharma as it unethically tries to navigate its lean times.

Martha Rosenberg of Evanston, IL,  is a freelance writer and editorial cartoonist. She has been a frequent contributor to the San Francisco Chronicle, the Providence Journal, and the Chicago Tribune. She has also contributed to the Boston Globe, the Los Angeles Times, Newsday, Arizona Republic, the New Orleans Times-Picayune, the Atlanta Journal-Constitution, Pittsburgh Post-Gazette, and Consumers Digest. In addition, she is a regular health columnist on the Huffington Post, AlterNet, CounterPunch, BuzzFlash, Foodconsumer, NewsBlaze, YubaNet, Scoop, and the Epoch Times. This article is reprinted from the Fall 2014 issue of The Trial Lawyer.

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