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Monday, December 11, 2006

A short note on "Big Pharma" and popular resentment 


[I]t occurs to me that -- while so-called "Big Pharma" may not be perfect -- drug companies have done a lot more to make my life better than their critics have. Maybe someone should point that out more often.

Indeed.

In our household, the miracle drug is called Copaxone. Not only do we owe this miracle to a pharmaceutical company, we owe it to an Israeli pharmaceutical company. Apart from George W. Bush and Dick Cheney, in some precincts it's tough to get more evil than that.

The pharmaceutical companies deliver extraordinary value to their customers, yet there is apparently great political advantage in bashing them. It is not obvious why this is so. Yes, we all wish the pharmaceutical industry would do certain things differently (I, for one, could easily go the rest of my life without hearing about "a strong, lasting erection" during prime time), but that is true of all industries. If I had to venture a guess, I would say that people resent paying money for drugs, no matter how much value they confer, because they feel they have no choice in the expenditure. Their doctor tells them that they need a prescription and they do not know enough to challenge the doctor's judgment. They have not budgeted for the expense because people do a bad job of planning even for known unknowns, so they also resent spending the money. The drug is not perceived as having value (even if it alleviates pain, calms the nerves, stems multiple sclerosis, thins the blood, lowers cholesterol, or ensures a strong, lasting erection), it is the thing that suddenly prevents you from paying for some less necessary thing. Never mind that the drug saved your life, or made your life worth living.

One often hears the claim that "big pharma" doesn't really do much research and development, and that the creative work is done by small companies that then license their compounds to the big drug companies. That is to a great degree true, but it misses the point: the development of a drug is vastly more complex than the discovery of an active compound. Not only must that drug be tested and trialed at an unbelievable cost that goes beyond the financial and technical means of most small "discovery" companies, but it must then be sold before any patient can take it. There is nothing more complex than the selling of any new medical technology. Why? Because the person who must be persuaded (your physician) is not the person who will benefit (the patient), not the person who will stock it (the pharmacy), and not the person who will pay for (most) of its cost (your insurer or employer). The small discovery companies are as dependent on big pharma as big pharma is on them, and all patients everywhere are dependent on the symbiosis between them.

There is also this myth that most new drugs are incrementalist and fundamentally unnecessary. Oh? If you are one of those people who believes that most new drugs are "unnecessary," honestly conduct this thought experiment: Virtually every drug invented before 1990 or so is "off-patent," and therefore available at a tiny fraction of its original cost. We could easily afford a dirt-cheap program to offer off-patent drugs to every American, but on the stipulation that they could never substitute any drug of more recent invention. While most Americans would have said in 1990 that their healthcare was pretty good, I submit that virtually all Americans would deeply resent a program that barred them from taking the new, more effective drugs that have become available since 1990. And with good reason.

The bashing of the pharmaceutical companies matches the popular dislike of the integrated oil companies. Me, I have nothing but admiration for big oil companies. I find it amazing that we can drill a hole somewhere in West Africa or the Arctic Sea or the jungles of Indonesia, pump out petroleum, ship it across the ocean, refine it into gasoline, and deliver it to my corner gas station, and pay everybody in between an adequate profit, for even $5 per gallon, much less the $2 or so that prevails at the pump as I write this. If you give the oil industry even a moment's thought, the complexity of its operations and the courage of at least some of its employees is simply astonishing. Yet politicians, who have a nose for the popular, love to bash oil companies, especially when prices are rising. Again, I think it is because people do not plan for volatility in gasoline prices, so when they have to pay more at the pump they do not acknowledge to themselves that gasoline remains such an extraordinary value that they will not do even the simplest things to use less of it.

Big oil, big pharma, and Wal-Mart. It is apparently in our nature to attack the businesses that have done the most for our standard of living.

49 Comments:

By Anonymous Anonymous, at Mon Dec 11, 09:29:00 AM:

You've got it. This is what happens when the "hate everything" MSM works it's will on a gullible electorate.

When the "world owes me a living" crowd outnumbers us, (and they already do, evident in the recent election results) we can only expect galloping revenge against everthing good. (National insanity.)  

By Blogger skipsailing, at Mon Dec 11, 09:57:00 AM:

The net result of socialism is always the same: Punishment of the successful.

big Oil, big Pharma, Walmart, the "rich" you pick em and the socialists will punish them.

It's what they do.

To understand this one must understand the underlying assumption. To the socialists life is a zero sum game. My success, such as it is, must have come at the expense of others. The socialists firmly believe that there is a finite amount of wealth and therefore my accumulation of wealth means that someone, somewhere is starving.

so the socialists look for victims. Walmart's victims are its own employees. Walmart can only be a success, the socialists assure us, because the company abuses it employees. They willfully ignore the facts on the ground, because they oh so inconveniently belie the socialist myth.

Big oil's victim is the environment. We will all "suffer" the socialists assure us, because big oil is victimizing us. First they got us addicted to oil, then they made it impossible for us to quit. Meanwhile a fact based argument about climate change rages, but again that's inconveniently counter to the socialist myth. Peak oil anybody?

Big pharma's victims are the poor who cannot "afford" the latest and greatest. The socialists will assure us that we are bad people for supporting an industry that manufactures products unobtainable by a class of victims that they themselves created.

We should do a simple excersize: pick a target of socialist wrath and attempt to identify the victim. Once we know the victim we can easily trace back to the socialists preferred method of punishment for the successful that must be lurking somewhere nearby.

How about PETA? let's focus on animal testing. The victims are poor widdle wabbits who have perfume sprayed in their eyes. And the successful that must be, therefore, punished? Those nasty cosmetic companies that make a fortune selling silly stuff to vacuous, insecure women.

see how easy this is?

You try it.  

By Blogger M. Simon, at Mon Dec 11, 10:12:00 AM:

A couple of examples of Big Pharma rent seeking:

The War On Unpatented Drugs.

Is Addiction Real?  

By Anonymous Anonymous, at Mon Dec 11, 10:15:00 AM:

You forgot Microsoft, and the cult of Apple that opposes it.

-David  

By Anonymous Anonymous, at Mon Dec 11, 10:16:00 AM:

I work for Microsoft. Trust me when I tell you how much I understand your last sentence in your post.

now to illustrate the my point, I fully expect other commenters to pile on about how big pharma, oil and Wal-Mart are all okay, but Microsoft is Eeeevil. (without really understanding or thinking about how that all came about in the first place anyway.)  

By Anonymous Anonymous, at Mon Dec 11, 10:21:00 AM:

Big Pharma may rent-seek, but that's at least in part because they have godawful expenses. Consider Pfizer, they recently pulled Torcetrapib from trials after 800 million dollars in testing. That's $800,000,000 in expense that they cannot get back. That's a lot of money, even by government standards.

Having said that, I'd prefer that Big Pharma not fight so hard against generics and patent expiration, but I would say that I understand it.

Oh, and you might also like this song: http://www.picobusiness.com/blog/index.php/2006/12/06/socialist-idiot/  

By Blogger M. Simon, at Mon Dec 11, 10:23:00 AM:

For those of you who will not click the urls here is the short version:

Marijuana is an excellent anti-anxiety drug. Few side effects. No attainable lethal dose. Big Pharma takes in over $40 bn a year selling anti-anxiety drugs.

Guess who some of the biggest supporters of the Drug Free America Campaign are?

Big Pharma.

Obviously they know their competition.

The drug companies do a lot of good. However, they are not pure as driven snow. In fact they are in part responsible for the murder, mayhem, and huge prison population caused by the Drug War.

It is not nice to jail people to maintain your profits.

It is worse that 2,000 innocents a year will be killed to keep the cash flowing. Just ask Milton Friedman.  

By Anonymous Anonymous, at Mon Dec 11, 10:25:00 AM:

TH -

I think your thought experiment is a great one. Of course, going down that path as a policy matter would be disastrous (just think about what the public resentment would do to product patent lives).

And, speaking of Copaxone, I'm not entirely sure of the nature of the deal but it isn't only an Israeli drug. While Teva Neurosciences was involved, there is some sort of licensing with sanofi-aventis (again, not sure of their role in all of this but they are definitely involved). So, the miracle drug is actually a combined effort between Israeli pharma and French pharma. Wow.  

By Anonymous Anonymous, at Mon Dec 11, 10:28:00 AM:

M.Simon: Reality check time. Yes,there are 'side effects' to medicines. For that matter, there are side effects i.e. consequences to everything you can think of. Find out what the downside(s) are and decide whether they are offset by the upside benefits.
The responsibilty of the individual is still the rule here. At least until January.  

By Blogger TigerHawk, at Mon Dec 11, 10:30:00 AM:

m. simon --

The idea that big pharma supports the "war on drugs" to keep weed from cutting into anti-anxiety ethical drugs is more than a little strained. There are obvious other public relations reasons, including the fact that our popular term for both heroin and Lipitor is "drug."

In any case, the popular opposition to decriminalizing pot has little or nothing to do with the efforts of pharmaceutical companies.  

By Anonymous Anonymous, at Mon Dec 11, 10:30:00 AM:

Thanks for including the post about helpful drugs. I work with a lot of pharma companies and get pretty tired of all the negative press.

I, too, have profoundly benefited from what these companies have produced, as have millions of others (who have little or no voice in our media environment):

http://impactiviti.wordpress.com/2006/09/29/clearing-clouds/
http://impactiviti.wordpress.com/2006/09/19/wanted-good-news/  

By Blogger Ryan Waxx, at Mon Dec 11, 11:08:00 AM:

For those of you who will not click the urls here is the short version:

Translation: If you are not interested in my propaganda, I'll shove it down your throat anyway. Because I'm speaking truth to powah!

Marijuana is an excellent anti-anxiety drug... (Big Pharma supports) the Drug Free America Campaign... they are in part responsible for the murder, mayhem, and huge prison population caused by the Drug War.

NEWS FLASH!

That gunfire you hear outside your window at 2am? That's not 2 quadrapelegic cancer victims shooting it out over the last hit of medical marijuana.

People who imply that legalizing pot is going to remove... or even reduce signifigantly... drug crime are more than propagandists - They are liars. If you want to legalize your way out of the drug war, you have to sell people on the virtues of crack and acid instead of playing a dishonest game of bait-and-switch. And that is a much harder proposition.

Guess who else supports the Drug Free America Campaign? Most police organizations. I guess they are just doing it because they want permanent employment. Yeah, lets demonize them too.  

By Blogger Assistant Village Idiot, at Mon Dec 11, 11:19:00 AM:

I would say that "strained" is a gentle phrase here.

Yes, m. simon, marijuana is an anti-anxiety agent. After that your argument slowly falls apart. It is not considered a competitor to the anti-anxiety medications in any formulary. There may be reasons to support marijuana legalization, but this isn't one of them.

TH - Beyond the socialist finite wealth argument, I think there is a more primitive one. Once a medicine exists, it is seen as cruel to deny it to anyone, and high cost is a form of denying it. This is another one of those tribal things, left over from the generations when we lived in hunter-gatherer bands of 100-150.  

By Anonymous Anonymous, at Mon Dec 11, 11:30:00 AM:

Skipsailing:

"The victims are poor widdle wabbits who have perfume sprayed in their eyes."

I agree with the need to do tests on animals.

Lets not make light of the animals used. A lot of the testing is cruel and painfull, that's why they use animals.  

By Blogger chsw10605, at Mon Dec 11, 11:32:00 AM:

The ABC's have been wonderdrugs in my home, too. Soon, I hope, my wife will receive the new T. Of course, Tysabri is considered even more nefarious because people actually died from drug interactions during its trials.

God bless you, and your family member who receives Copaxone.

chsw10605  

By Blogger RebeccaH, at Mon Dec 11, 11:39:00 AM:

Wise words, indeed. I am on seven different compounds, and God, I would love to get off some of it, but I'm smart enough to know I'm alive today because I'm taking them. If Big Pharm was discouraged from producing drugs like that, what would people like me do? The answer is die early, and that answer satisfies some people of a certain mindset.  

By Blogger M. Simon, at Mon Dec 11, 11:51:00 AM:

If pot is not a competitor to regular anti-anxiety drugs why would Big Pharma waste its money on the "Drug Free America Campaign"?

On top of that drugs in the amphetamine (stimulants) class are used for ADD/ADHD. Like methamphetamine. So when a doctor prescribes a stimulant it is all okey dokey. If you get the same drug from the gypsey drug store or make your own you are in deep horse excrement.

It is curious that when a stimulant goes off patent it frequently gets added to the Schedule I list. Well I find it curious. YMMV.

I guess drug companies are above using government to prop up their profits. Unlike most other businesses in a similar situation. Why not act in your own self interest if you can use the government as your cut out? Done all the time.

There are a lot of iron rice bowls dependent on the prosecution of the drug war. The drug companies are just part of the equation.

National Socialism is alive and well. In a somewhat attenuated form. Corporate socialism. At lest we are not going after the Jews. Yet.

As I said. Big Pharma does a lot of good. It is not above using government to protect its profits. It does it so well that even when presented with evidence (circumstantial at this time) people deny the connection.

As to pot being no competition to anti-anxiety drugs: This Israeli researcher (he discovered the CB1 system in the brain - CB being short han for cannabinoid) begs to differ.

PTSD and the Endocannabinoid System

We have a HUGE PTSD problem in America. Except we don't call it PTSD. We call it anxiety.

Some doctors say Cannabis is the Best Medicine.

In fact in the medical community all this is A well known secret.

This will all come out in time. When it does it will blacken the reputations of a lot of American institutions. Unfortunately the good Big Pharma does will be ignored to pile on them for support of the drug war.

Just as I expect it will destroy a lot of support for Republicans.

I'd like to see both of those institutions give up their support of prohibition before they get destroyed by that support.

Well, I'm a lone voice crying in the wind. Today.

The science will be popularly recognized in time. It will not be good for institutions and individuals supporting prohibition.

Note I have not even covered the criminal or terrorism implications of all this. I will leave some food for thought:

Do Republicans support drug prohibition because it finances criminals or because it finances terrorists?

Republican Socialism. Price supports for criminals and terrorists.

And Big Pharma I might add.  

By Blogger Quadraginta, at Mon Dec 11, 12:02:00 PM:

If I had to venture a guess, I would say that people resent paying money for drugs, no matter how much value they confer, because they feel they have no choice in the expenditure.

I'm going to be a lot more cynical and say the reason people bitch about Big Pharma is basically because people are not too bright.

When a heart arrhythmia kills you in months, everyone is grateful when Big Pharma produces a drug that staves off the problem and lets you live for years, if not decades. But once everyone who has the arrhythmia gets the drug, and there aren't plenty of folks dying to remind the folks living of what's at stake, then resentment begins

The only reason people don't equally resent heart surgeons is because what they can offer doesn't work nearly as often. There are plenty of cases where the surgery doesn't work to remind the winners of what they've won.  

By Anonymous Anonymous, at Mon Dec 11, 12:04:00 PM:

M.Simon: I didn't realize that marijuana was "our friend" and that "big pharma" was our enemy.....

You sound like a true pothead.  

By Anonymous Anonymous, at Mon Dec 11, 12:17:00 PM:

Regarding the marginal improvement issue-I use to take Prilosec for gastritis. I was limited on foods and consumed Tums like M&Ms. Along came Nexium a "marginal improvement" and I was given a new life free of antacids and back to enjoying wine, coffee, etc.Life is wonderful and I am greatful to big pharma for that opportunity.  

By Anonymous Anonymous, at Mon Dec 11, 12:19:00 PM:

"If pot is not a competitor to regular anti-anxiety drugs why would Big Pharma waste its money on the "Drug Free America Campaign"?"

A more perfect example of begging the question would be hard to find. I'll have to remember that one when I am giving examples of logical fallicies.  

By Blogger Ryan Waxx, at Mon Dec 11, 12:33:00 PM:

> Do Republicans support drug prohibition because it finances criminals or because it finances terrorists?

So, Msimon, when did you stop beating your wife?  

By Blogger Gordon Smith, at Mon Dec 11, 12:59:00 PM:

Crying victim, Hawk?

Those mean old liberals talk a lot of trash about pharmaceutical corporations, but they don't look at the good things Big Pharma does! Liberals who ignore all the good things and focus only on the price-gouging and government subsidization are the same people who say that things aren't going swimmingly in Iraq!

Bollocks.

I'm glad that drugs are available to those who need them. Great work on the part of the Pharma. Excellent.

Now are we allowed to criticize? Are we allowed to say that runaway profits are due in part to de facto government subsidization, in part to marketing drugs to people who don't need them or who could do as well on a cheaper drug, in part due to blocking competition from Canada?

Can we say that it appears that big drug companies aren't driven primarily by the desire to help others but instead by the desire to make the largest profit? It's true after all. Profits aren't evil, but they're real. And when the government is in cahoots with Big Pharma to keep prices artificially high, whose responsibility is it?

Maybe the free market will fix this problem, eh?

Enough whining about socialists when it's the Republican administration that propped up the drug companies through the Medicare Part D giveaway and by blocking reimportation.  

By Blogger skipsailing, at Mon Dec 11, 01:15:00 PM:

Oh please, screwy, can you walk the dogma for even a minute here?

Right to motivation, yup, that's our socialist friends:

Can we say that it appears that big drug companies aren't driven primarily by the desire to help others but instead by the desire to make the largest profit? It's true after all. Profits aren't evil, but they're real.

so what Screwy? I mean what does all that blather actually mean? It seems to me that you're saying that drug companies motivation is less than politically correct, therefore they are a worthy target of socialist ire. Everybody, in that case, would be a worthy target of socialist ire. Once again the jacobins are on the march.

Do you guys go to like group therapy sessions where you learn to live with your internal conflicts?

here's a perfect example:

...it's the Republican administration that propped up the drug companies through the Medicare Part D giveaway and by blocking reimportation.

You're bitching about the actions of our government today because it did something you don't like, but no doubt you'd love to see the government run the entire healthcare industry. How does that make any sense at all?

How do you guys deal with this apparent contradiction anyway?  

By Blogger Bret, at Mon Dec 11, 01:20:00 PM:

Tiger Hawk wrote: "The pharmaceutical companies deliver extraordinary value to their customers, yet there is apparently great political advantage in bashing them. It is not obvious why this is so."

One obvious answer comes from the "any profits are evil" crowd. Perhaps that even explains most of the big Pharma bashing. But let's ignore this explanation for now since I don't agree with them because I'm all for profits in open and competitive markets.

My perspective is different: I'm very suspicious of any industry whose profits are the result of monopoly rents. And I think that despising monopolies is very much part of the American psyche.

Firmly believing that "pharmaceutical companies deliver extraordinary value" requires an inability or refusal to think outside the box. The four sides of this "box" are the series of monopoly rents imposed by the Patent Office, the AMA, the FDA, and big Pharma. Within this box, I would agree that pharmaceutical companies deliver value. However, I think the box is extremely expensive, both in terms of money and health, and once that's taken into account, I'm not convinced that there's any positive value at all delivered outside the box. If there is value delivered outside the box, I doubt it's extraordinary - it's at best marginal.

There are, of course, gazillions of arguments about why each of those four sides of the box are necessary and I can't possibly begin to address them in a single blog post. Each one of those arguments, however, is only valid within the box. If the box didn't exist, if drugs were developed and deployed using another paradigm, the arguments wouldn't be valid. In fact, they'd be nonsensical.

(The above is an excerpt from this post.)  

By Blogger Assistant Village Idiot, at Mon Dec 11, 01:26:00 PM:

m simon, I'm glad to get into the discussion, but you should know going in that I've made my daily bread in an acute psychiatric unit for 30 years, and may be able to draw on actual knowledge. We really do need to know the answers to these objections to counter them when our patients raise them.  

By Anonymous Anonymous, at Mon Dec 11, 01:41:00 PM:

To those that decry the Pharma companys' rent-seeking:

"Big Pharma" is comprised of many tens of thousands of individual human beings. In today's American mixed-economy, where government has succeed-or-fail (and sometimes even life-or-death) power over many aspects of our lives, it is inevitable that some of those people will be tempted by the prospect of benefitting from the rent-seeking gravy train. (In some cases, they may actually be justified in seeking these "favors" in that they would directly nullify an unjust disfavor). To expect any collection of more than a handful of people to be "pure as the driven snow" in not playing this game is simply Utopian.

Any industry must be judged on its fundamental mission, which, in this case, is to develop life-enhancing and life-saving drugs (and to profit in selling them, that they may benefit from the value they provide). The negative behaviors cited in the above comments are all directly the result of government-imposed market distortions.  

By Anonymous Anonymous, at Mon Dec 11, 02:32:00 PM:

Screwy:
Are we allowed to say that runaway profits are due in part to de facto government subsidization, in part to marketing drugs to people who don't need them or who could do as well on a cheaper drug, in part due to blocking competition from Canada?

Or, you know, maybe prices are so high here because the Canadian government forces those same Pharma companies you are bashing to sell their drugs for cost —which does not include initial R&D or testing— so they have to make up the expenditure, and acquire funding for their next project, elsewhere.

Nooo, it couldn't be that our neighbors to the North and across the Atlantic are actually the ones helping to drive up the cost of pharmaceuticals in the US by not paying their fair share.

Fact is if we got 'cheaper' drugs from Canada the Pharma companies would soon go out of business as they would be unable to recover basic costs. Medicine in Canada is not cheaper because of 'competitors' it is cheaper because of typical socialist price controls.

(The Pharma companies go along with this to keep 3rd parties from being encouraged by those same cheap skate governments to break patents; not altruistic, but necessary or else the same consequence as reimporting the 'cheaper' drugs occurs)  

By Blogger J. Peden, at Mon Dec 11, 02:35:00 PM:

At least when screwy appears, I don't have to worry whether screwy's post is the one above or the one below.

I'll also wager that screwy - or anyone else of the like - spends more on such things soft drinks, energy drinks, latte's, grooming, broken mirrors, etc./day than anyone with combined diabetes, heart transplant, lupus, schizoprhenia, and cancer of the gonads does.

Nor does screwy's ADD seem to be in very good control. Big Phama has again betrayed screwy.  

By Anonymous Anonymous, at Mon Dec 11, 03:11:00 PM:

Conjecture: Popular resentment toward Big Pharma results from the collision of two forces: (1) a sort of intuitively held folk Labor Theory of Value and (2) an industry's having high fixed/upfront costs & low marginal costs.

E.g. "It cost Merck $1B to make instance #1 of their new pill, but it cost them only $0.01 to make instance #734,185 of it, and since that's the one I'm holding, I should only have to pay Merck some small multiple of $0.01."

This conjecture also explains why people demonize Microsoft, Anonymous. "Maybe they spent $$$$$$$ to create their warez, but the disk I'm holding cost them only pennies to make, so why should I have to pay $100 for a copy of XP?" Same with Big Music vs. Napster, and why people "steal" music off the internet. And so on.

It also explains why you do not see a comparable widespread demonizing of industries with unreasonable prices (Big Food, anyone?) but with lower upfront costs and/or higher marginal costs.

Corollary: if this conjecture is true, then the resentment will grow over time, as more and more of our economy shifts into industries that have an ever-larger upfront investment into R&D, followed by small-or-zero marginal cost of production.

-gopher  

By Anonymous Anonymous, at Mon Dec 11, 03:54:00 PM:

Who would have ever guessed it? The big Pharma exists to sell anti-anxiety drugs. Thanks to their ability to bribe our entire government, our nation is deprived of the wonder drug, marijuana, that will cure cancer, hold diabetes at bay, and keep the failing hearts pumping. To those of you straining to make arguments about monopolies, rent something or other, just start your own drug company, discover a drug that will cure cancer and reap the monopolistic trillions you so richly deserve.  

By Anonymous Anonymous, at Mon Dec 11, 04:18:00 PM:

Ryan Waxx,

That gunfire you hear outside your window at 2am? That's not 2 quadrapelegic cancer victims shooting it out over the last hit of medical marijuana.

It's not winos shooting it out over the last of the bathtub gin, either. Nor is it people whose business is smuggling whiskey over the Canadian border.

If you want me to think the Prohibition analogy doesn't apply here, I'm going to need that explained to me. Specifically for pot, as we aren't talking about legalizing crack or meth, and including an explanation of why your argument doesn't apply to alcohol as well.  

By Anonymous Anonymous, at Mon Dec 11, 04:32:00 PM:

I can say with almost complete confidence that I know more about the brand and generic drug industry than any of you. I've worked as an attorney for the brand side in numerous patent litigations. It's in my professional interest to know as much about them as possible.

Brand companies are, well, businesses. And like all businesses they are about making money. That's how they stay in business. But the people involved in the companies, particularly at the research level, are about helping people and saving lives. But money focuses how they can do their research.

There are some bad behaviors on the business side, usually caused by quirks and bad incentives in our laws. One quirk is that research-based companies generally won't spend development money on drugs they cannot patent. (Compound protection is MUCH greater than use protection).

Generics, incidentally, generally are MUCH more money-grubbing and frequently scum. They contribute nothing to society except cheaper drugs.

By the way, I'm a cancer survior. I'm alive because of Big Pharma. And they gave me good drugs when I was a poor, dying, student and unable to afford them.  

By Blogger William, at Mon Dec 11, 05:39:00 PM:

I have one complaint with 'big pharma'- I do not believe they should be allowed to advertise prescription drugs on television. Or to the general public, for that matter.

Who are we to know what drug is best for us? Drug companies should make their cases to the doctors, who know what they're doing, and can then recommend a drug per ailment to a given patient.

Banning prescription drug advertising to the general public would save all the drug companies alot of money while allowing doctors to make wiser choices.

Always has seemed like a good idea to me, but I'm no drug expert. Any problems with it?  

By Anonymous Anonymous, at Mon Dec 11, 05:45:00 PM:

We used to ban direct to consumer advertising. But violates commerical free speech and is therefore unconstitutional.  

By Blogger Bret, at Mon Dec 11, 06:18:00 PM:

william wrote: "Who are we to know what drug is best for us?"

Ouch, I cringe at that perspective! Should there be no over-the-counter drugs then? No supplements, vitamins, etc.? Should we only eat what doctors and nutritionists tell us and nothing more? Should we only buy a car that's recommended by the local car dealer (since he probably knows more about cars than we do)? Should we only invest where experts tell us? Should we have each and every moment of our day planned for us by people who know more than us?

I think not.

First of all, while most (perhaps all) doctors know more about medicine in general than I do, none of them know more about ***me*** than I do. A team consisting of a doctor and me has more information available to it than just the doctor acting alone. When I'm sick or injured, I do extensive research on the Internet regarding my problem.

Also, any two doctors may have different opinions (thus, the concept of getting 2nd and 3rd opinions). By knowing as much as possible yourself, you can best discern which opinions are most likely to work best for you.

Advertising is part of getting that information to me. If you don't want it, fine, ignore it, but don't advocate policies that keep me in the dark, thank you very much.  

By Blogger Kurmudge, at Mon Dec 11, 06:26:00 PM:

As with most of these situations, both sides are a bit overstated. Pharmas are staffed by real people with the same human motivations, neither wholly saint nor sinner, as drive all of us. A lot of nonsense goes on in the attempt to find the next blockbuster or cash cow, but that is also what finances the research into very real treatments for very real problems.

M. Simon's comments read a lot like the standard anti-DEA stuff. In reality, if we are going to have some kind of regulation of pharmaceuticals (Goid help us if we don't), pot and morphine should be handled in exactly the same way as is any drug. Do research, even if Priscilla Goodbody has terrible memories of "Reefer Masdness" lingering from her sheltered youth, and if the substance is efficacious and reasonable in risk, approve it for prescription by licensed persons. Incidentally, that is exactly what we should do for THC-containing substances needed by cancer patients.

Is a lot of initial compound drug discvovery done outside of Big Pharma? Sure- in acedemic research institutions such as my own, in small start-ups (most often spun off from research universities), and then in companies big enough to play with basic research. But even if Pfizer or Merck never did a thing except conduct clinical trials and market approved substances they would be performing an irreplaceable function in the healt care world and promoting medical progress.

Drug companies have obvious biases and vested interests- just like governments, unions, and professors. At least we KNOW what Pfizer's motives are, and we adjust for them. We citizens have control over patent life through our elected representatives, and th rules are well-known. If there is a problem it is with lazy or overworked medical people who don't get educated enough to deal with the avbailable information on what to use for what and how to dose effectively- relying instead on the mellifluous oozings of pharma salespeople.

M. Simon is a bit over the top, just as Marcia Angell was a LOT over the top. What needs changing is 1) a stronger orphan drug program to ensure that the "lower value" markets get attention (glioblastomas are not ubiquitous, thank God, but we need lots of work on brain tumors, while GSK goes for asthma, also important); and 2) there is a huge body of work to do now in combinational therapies, a lot with drugs that are off-patent, so no one wants to invest in working with them. And the pharmas do get ugly about combos and adjuvant therapies, demanding assignments of IP, etc. that prevent you from using two compounds together. That is where the progress could be made if FDA would twist the arms of the drug companies.

But we need them, and they mostly do great things. For a price!  

By Anonymous Anonymous, at Mon Dec 11, 07:37:00 PM:

William -

I think there's certainly a place in pharma for advertising directly to consumers (be it TV ads, radio or print).

1) There are some conditions, particularly those where we can diagnose ourselves (e.g., insomnia or allergies) where advertising to send patients to the doctor's office makes sense.

2) There are also some ads that are really aimed more at reminding patients of the importance of taking their medication than to specifically go to doctors and ask for a prescription - essentially, this is an attempt to improve adherence to the prescribed regimen. Osteoporosis drug advertising is close to this.

3) There are some other conditions that may be dangerous, but have reasonably benign symptoms that a patient might not bring up with a doctor unless prompted - potentially through advertising. The best example I can think of here is the advertising for Peripheral Arterial Disease (PAD) by BMS and sanofi-aventis: a condition that can be treated by one of their drugs (Plavix). PAD puts a patient at tremendous risk of a cardiac event, but the symptoms don't necessarily lead one to that conclusion.

Are there other drug ads that serve limited public value? Sure. The "Celebrate" ads for Celebrex come to mind quickly - but let's not throw the baby out with the bath water by putting down a blanket prohibition on consumer advertising.  

By Blogger William, at Mon Dec 11, 11:05:00 PM:

Anony, valid point, but don't we ban tobacco advertisements?

Bret, I speak of prescription drugs, not over the counter medications, and lack of general advertising would not prevent those willing to research from accessing information and making independent assessments.

Howard, you have valid points.

Perhaps a ban on explicit product advertising, and instead replacing it with advertising outlining symptoms, connecting them with an ailment, and directing watchers to the doctor. The drug company will still benefit if their drug is of sufficient quality that the doctor recommends it, but will not create the clamor of patients demanding flashy drugs of limited value or use.

Does that get the baby out before we drain the bath?  

By Blogger BlackOut-NC, at Mon Dec 11, 11:19:00 PM:

Some folks just love to show up in the comment thread and say, "cancer of the gonads".

Let's not hate on it.

"I'll also wager that screwy - or anyone else of the like - spends more on such things soft drinks, energy drinks, latte's, grooming, broken mirrors, etc./day than anyone with combined diabetes, heart transplant, lupus, schizoprhenia, and cancer of the gonads does."

My ideas are worse because I don't have diabetic, schizophrenic, cancer of the gonads.

And, Peden, you're a funny guy. I think you've got a real wit hiding in there, but you pegged me wrong. Try again. I love the attention you know?

And, everyone else - 37th in the world.  

By Blogger BlackOut-NC, at Mon Dec 11, 11:19:00 PM:

oops,

alter ego alert.

This is Screwy Hoolie.  

By Anonymous Anonymous, at Tue Dec 12, 02:21:00 PM:

I think most people overanalyze the reasons the perceptions of the pharmaceutical industry is negative. It is not because of profits, it is not because of supporting the drug war, it is not because people believe they are evil (except maybe Mike Moore, who has his own agenda). The reason Americans have a thing for the industry is discrimination pricing. Why should a Canadian be able to buy the same drug, made by the same manufacturer, for half the price that a US citizen has to pay? Why should a poor homeless person in San Francisco not be able to get free AIDs drugs when a poor person in Africa gets it for free?

You see this all the time in all areas. You can be perfectly happy with the salary you receive, until you find out that the person in the next cubicle makes more, then you get pissed off. A pro athlete can be happy as the highest paid person on the team, but if a talented rookie signs for more, watch out.

The US pays for the research that supplies the world with the drugs of tomorrow. We have chosen a "free" marketplace, while others use other forms. It doesn't stop the rich from other countries from coming here to receive the latest treatment or to receive the latest drugs, but that's how they have chosen to operate. I understand that this pricing allows for higher overall profits, but if the US decides to go the same route, then of course development will be curbed, and none of us will have all these nice new drugs.

The problem with these facts are that they are not easy to understand, you can't put them on a bumper sticker. I can easily believe that politicians will use pricing as their election slogan and win. We won't like the result. Healthcare might become cheaper, but it won't be as good.  

By Blogger J. Peden, at Tue Dec 12, 03:50:00 PM:

screwy:"Let's not hate on it....My ideas are worse because I don't have diabetic, schizophrenic, cancer of the gonads."

Right, that's what I meant.

Therefore it would be "better" if you have Korsakoff's Syndrome, as now appears likely?

But no worries, I just like to say that too.  

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