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The Disrespectable Pharmaceutical Industry

Over the past few weeks, we have been hearing about a couple of unsettling stories involving the pharmaceutical industry, one involving suicide under pressure and the other, about the exorbitant cost of life saving EpiPens.

Suicide Under Pressure

On August 11, the New York Times carried a story titled “Driven to Suicide by an ‘Inhuman and Unnatural’ Pressure to Sell.” Here we learn about a 27-year-old salesman for Abbott Laboratories who rode his motorcycle to a remote railroad track and jumped in front of a train.

Friends of Mr. Awasthi visiting the spot where he committed suicide. Credit: Atul Loke for The New York Times 
He left a note that said, “I’m going to commit suicide because I can’t meet my company’s sales targets and my company is pressuring me.” More than 250 fellow Abbott drug sales personnel walked off the job for a day, protesting what some called the company’s overly aggressive sales policies that compromised patient health.

drugs 4A six-month investigation by The New York Times found that in the push to win customers, some Abbott managers instructed employees to pursue sales at virtually any cost. Among the ploys used to sell drugs, Abbott managers told sales staff to hold what the company called health camps, where representatives would perform tests on patients for various ailments in an effort to drum up business for doctors, who would then prescribe Abbott drugs.

The article goes on to tell us:

Rajeev Khanna, who managed six sales representatives for neurology medicines in northern India, said he was fired after complaining to Abbott’s office of ethics and compliance that his team was submitting fake invoices to increase sales.

The Life Saving EpiPens

Immediately on the heels of the suicide story, I began to hear the media uproar over the marketing strategy by the company that manufactures EpiPens.

Between 1 and 2 percent of people who have particularly strong allergic reactions can go into a state known as anaphylaxis, when their airways swell and close. Fortunately, there’s a simple treatment for such reactions–Epinephrine. Epinephrine is very, very cheap. It costs less than a dollar per milliliter, and there’s less than a third of that in an EpiPen.

But to save a life, Epinephrine must be delivered quickly and in the proper amounts. People suffering severe allergic reactions often can’t do it themselves. Drawing the drug into a syringe and then administering it to someone else requires training and precision that most people lack. The EpiPen was created so that pretty much anyone can deliver the proper dose with no special training. Pull off the safety cap, put the tip against the thigh, and push. Boom. Epinephrine delivered.

According to the New York Times,

The EpiPen isn’t new; it has been in use since 1977. Research and development costs were recouped long ago. Nine years ago, it was bought by the pharmaceutical company Mylan, which then began to sell the device. When Mylan bought it, EpiPens cost about $57 each.

Unfortunately, research shows that Epinephrine degrades pretty quickly over time, and therefore it is recommended that EpiPens be replaced every year. People who have serious allergic reactions need to store EpiPens in several easy to reach places, so they often need to buy several.

drus 9Mylan has a veritable run of the market. It therefore, in a few short years, raised the price of EpiPens again and again. As of this May, they cost more than $600 a pack. Since 2004, after adjusting for inflation, the price of EpiPens has risen more than 450 percent.

The government encourages the product’s use, but makes no effort to control its cost. As the New York Times article concludes:

EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system.

Responding to the national outrage over high prices, Mylan announced plans to launch the generic version in “several weeks” at a cost of $300 per two-pack carton, compared with $608 for the branded EpiPen. But this lower price is still more than four times the cost just a few years ago.

drugs 10These latest two media stories are just a tip of the iceberg when it comes to how the pharmaceutical industry is treating its customers disrespectfully. Anyone who really wants to know the full story would do well to read Dr. Marcia Angell’s superb book, The Truth About the Drug Companies: How They Deceive Us and What To Do About It. The author has an M.D. degree, and for two decades was editor in chief of the prestigious New England Journal of Medicine. There she had a front row seat on the growing power and corruption of the industry.

What Dr. Angell Reveals


The most startling fact about 2002 is that the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion) . . . When I say this is a profitable industry, I mean really profitable. It is difficult to conceive of how awash in money Big Pharma is. (Marcia Angell)


drugs 1As Dr. Angell powerfully demonstrates, claims that high prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into marketing of their products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.

One of the most harmful practice occurring today is the pharmaceutical industry’s practice of creating “me-too” drugs. Instead of using their vast resources creating new drugs to improve treatment or tackle diseases that have no current effective treatments available, the industry typically places most of their research efforts to create a drug that does the same thing as an older drug that is about to lose its 20 year patent rights. Since, upon losing a patent right, a company realizes that other companies can begin to sell the drug at a reduced, more competitive rate, a company will change one molecule of the old drug, or make some other slight change, and then quickly look to see if the change does not lead to any loss of treatment effectiveness. If it proves to be just as effective, as it often is, the company will then seek a fresh new patent for what it claims is a brand new drug. Once a new patent is obtained, the company then begins to market the “new” drug on TV and in magazines, claiming it is the latest advance in the treatment of the particular disease, and the actors in the ads claim that they were hoping to get relief for years but only now, since the “new” drug became available, they finally feel well. Patients begin to demand that their doctor prescribe the new drug, which is far more expensive than the old drug that had been available for years but is no longer under patent protection.

drugs 11How do the drug companies get away with this, since a patent is only supposed to be issued when the new drug is useful, novel, and non-obvious. The drug companies have the largest army of lobbyists in Washington, D.C. If you think the gun lobby has an unfair hold on politicians, it is small potatoes when it comes to the pharmaceutical industry.

Some from the drug companies argue that they are only doing what the free market allows. But that is far from the truth. Through its lobbying efforts, drug companies have become utterly dependent on government-granted monopolies in the form of patents and FDA approved exclusive marketing rights.

drugs 5How do drug companies justify all of their me-too drugs? They claim that it is good to have more than one drug to treat a condition, because if the first one doesn’t work, the second might. Here’s Dr Angell’s reply:

[T]here is little evidence to support the notion that if a particular drug doesn’t work for a patient, a virtually identical one will. Or if one drug causes side effects, another one won’t. The companies could easily test this proposition. They could test their me-too drugs in patients who have not done well on the first one. But they don’t do that, probably because they don’t want to know the results–if Prilosec doesn’t work, Nexium probably won’t, either. They simply compare their me-too drug with placebos.

The above critique of the drug industry is really just a little taste of what is wrong. Other quick examples are, drug companies often rig clinical trials to make their products look far better than they are, and they use their legion of lawyers to stretch out for years government-granted privileges that run completely against the interests of the vast majority of its citizens.

What Can Be Done? 

drugs 6The solution to getting the drug companies to start treating us respectfully would be fairly easy if only Congress could fire up the will to stop listening to the industry’s lobbyists. Laws could simply be enacted that would replace the 20 year patents on new drugs with laws that would provide a patent that lasts only until the company recoups its investment in creating the drug. When the patent runs out, they could still continue to sell the drug without the patent. After all, companies that sell off-patent generic drugs do make profits, but just not as outrageous profits that allow the industry to employ more lobbyists on Capital Hill than there are congressmen.

Furthermore, laws can be easily enacted that would stop giving patents to companies when they create me-too drugs. If a drug company really believes creating me-too drugs are beneficial for their customers, they could still create and sell them at a modest profit.

There are several other laws that also would have to be passed to put a stop to all of the disrespectful actions, most of them neatly laid out in Dr. Angell’s book. None are difficult to achieve if Congress wanted to act.

drugs 7Unfortunately, the influence of the lobbyists have been way too great for the lawmakers to resist going along with the drug companies. So, as is often the case, it is up to those of us who are being treated disrespectfully to stand up and powerfully advocate that we begin to be treated respectfully. drugs 8This would entail making it known that we voters will only support candidates who are running for office who refuse to take money from the pharmaceutical industry. If there are no such politicians running in the district we live in, we must identify someone who is willing to run on this issue, and then we must work to get that person elected. Without such action, we folks will have to accept that being treated disrespectfully by the drug companies is just a sad part of life.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

About the Author

Jeffrey Rubin grew up in Brooklyn, received his PhD from the University of Minnesota and has taught conflict resolution there as well as at a psychiatric clinic, a correctional facility and a number of public schools. He has published articles on anger and conflict resolution and has authored three novels.

3 Comments

  1. Very important post, Dr. Rubin. I hope it generates a wave of protest against Big Pharma.
    Kathie Malley-Morrison

  2. We NEED major drug reform! Big Pharma is killing us in more ways than one!

  3. This issue needs every voice behind it. Thanks and keep up the good work! As a psychologist, I see how this issue harms children and adults who are put on medications that cause permanent brain damage without any effort by the doctor to refer them to therapy. Big Pharma and psychiatrists have falsely promoted the myth of “chemical imbalance in the brain” as the reason for “mental disorders.” Just so they can sell meds. It’s shameful.

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