Dr. Angell mentioned a research publication on clinical trials of antidepressants in which the authors obtained protected information from the FDA by using the Freedom of Information Act. The upshot of the paper was that the pharmaceutical companies were/are promoting their products by presenting cherry-picked results from a body of data that was altogether underwhelming. Could you provide the reference so I can read that paper.

Somebody might…

This is not a minor quibble. “Everybody knows” that industry is rapacious yada yada. However, every time someone does something in an inefficient manner, that creates a market opportunity for someone else.

Furthermore, drug companies have good reasons to prefer to market a cure if at all possible.

Assuming they’re hedonically equivalent, the proper price for a cure is the discounted current value of the cost stream for the continuing therapy. However, pharma has an incentive to produce cures at this price rather than treatments, because pharma would severely discount potential profits from drugs that are due to go off patent. In other words, if $100 for a cure now is worth the same to the consumer as $10/year for 20 years for the ongoing therapy, they will be indifferent to whether to buy the cure or the therapy — but the drug company, who would get the whole $100 but who will only get a few years of the $10 because the drug will go off patent before 20 years are up, would hugely prefer the cure.

-dk

Don’t get me wrong. I agree that Pharma is a corporate behemoth whose role in society is primarily to make money–lots of it. Lots and lots of it. To do that it spends to control Congress, the FDA, and to influence doctors, medical schools, pharmacies, and the whole healthcare delivery system. It’s power is far beyond what any institution of any kind ought to have and the primary potential countervailing powers: politics, the academy, the insurance industry are either in bed with Pharma or problematic in their own overweening power (i.e., the insurance industry).

My disagreement is that she undermines the forcefulness of her critique by not being discriminating enough in her arguments. So many of the anecdotes that had our dear Chris reeling and tsk-tsk-tsking were hoary old chestnuts that have little basis in fact. For example, she claims that there is no difference between drug A and drug B if drug B is a slight chemical variation on drug A. She argues that the only reason that drug B is developed is when drug A is successful, drug B is designed as a “copycat” drug to share in drug A’s profits, or if drug A’s patent protection is running out. The argument is so off-base it’s neither right nor wrong, though mistaken. It’s beside the point.

The problem with her charge is that it looks at the profit motives of Pharma as the basis for deciding on whether a drug is of any value or not. Well, that’s just plain silly. That’s like looking at your children and judging their value based on the motives that lay behind the act that brought them into existence. Now, I realize that most people are thinking only high-minded thoughts about the future of the human race, about the joys of parenthood, about keeping faith with the ancestors, and similar lofty things when they have sex. I, however, must confess that I had nothing so lofty on my mind during the act in which my children were conceived. I was bloddy EXCITED and having fun and full of love and lust. Do my kids therefore have less value because the motive behind their origin was not the good of humanity, but carnal satisfaction? (It’s ok. I can say this. I’m ordained.)

Judge the drug on its effects, not on the motives that produced it. The body is not a machine. My body does not react to a drug the same way your body does. Ever so slight variations on a drug may make a copycat and bring oodles of filthy lucre to Pharma, but that copycat may save a life or make a person’s suffering more bearable (but, I forget, Marcia discounts the suffering of those whose pain is the result of a “life-style” disease, like depression, ADHD, obbsessive-compulsive disorder, and other neurological disorders she and Chris think are inventions of Pharma) That is the strange irony of capitalism: dirty profit motives can, indeed, lead to things that improve the life of the world. Sometimes.

And that is why I’m mad at Marcia. Big Pharma is SO big and powerful that it is less and less subject to the laws of the free market. Markets are only free when there are countervailing powers that keep market actors from getting so powerful they eliminate market forces. Instead of driving that point home over and over and over again (with powerful, convincing evidence she marshalls with ease and great skill), she forays into anecdotal arguments and dredges up statistical studies that conceal rather than reveal the possible effectiveness or dangers of a drug.

No, I’m sorry I must disagree with most of you who think this program was a decisive blow against Pharma. All her Pharmic opponents have to do is blow on the smoke she provided with her indiscriminate arguments to continue to obfuscate and blind the American people.

Do it again, Chris. Big Pharma hardly had a glove laid on it. Some of us are still waiting for someone with a sling and five smooth stones to bring this giant down (a reference that I’m sure that my brother, Chris, will get).

And Chris, acknowledge that your own biases against mental, emotional, and behavioral disorders and those who you think “create” them. We need the strongest arguments we can get against the drug industry; I’m afraid your prejudice in this matter weakens your usually marvelously clear thinking and trivializes those who suffer things you don’t believe in and strengthens those who exploit them, and us.

I missed the show and will listen today but reading this thread I broke out in a sweat and my heart is beating fast. This AM I go for my allergy shots- have been doing this for 15 years- and as I sit in the waiting room I watch the parade of young well-dressed reps, each exuding an endearing personality, carrying bags full of samples and/or a treat of hot coffee and donuts for the Dr. and his staff. They are wecomed. The chatter is friendly and even personal. I sign in with a funny pen and mark my next appointment on a paper provided with a drug company logos. Pencils and pens stick out of mugs with more logos. I grab a tissue to wipe my runny nose from a box with a drug company logos. The Dr’s rooms are fillled with such “chochkas”.

To be sure I have walked out with my free samples. A tiny bottle of nasal spray, last time I checked which was several years ago, was retailing for $57. I have no idea how this price has increased, which surely it has since, because the price is masked through my drug plan.

I am well aware, being so sensitive, that drugs can exacerbate the very symptoms that they are supposed to relieve. I am so sorry and frightened by Kate’s tale, but warned again, to be careful and to watch out… watch out for your loved ones as well.

Thanks for the great posts.

Please belive me I do know it isn’t easy. Perhaps I was being cavelier but the reason I understand that depression can be caused by jobs is because I’ve had so many really crappy jobs.

rc21: You are so funny. Have you ever met a hippy? There is a big difference between hippies and Phamcutical Corporations. People who sell pot go to jail. People who sell Prozac get rich.

there is no doubt in my mind that the cause of her dementia is her pill cocktail. i live far away and have little or no influence over the situation.

I’ll take her seriously on the economic issues, but on the practice of medicine she’s not serious herself. She’s a scold and off-base on the actual effects of the drugs. For example, slight changes in SSRIs, for example, make it possible for the “tweaked” drug to help some that the “original” doesn’t touch. The number of variables involved in connecting to neurotransmitters is staggering and the idea that there could be one drug for all is wishful thinking.

Her charge of “lifestyle” drugs to criticize drugs used for the famous ED is smugness to its height. Of course if you’re a staid new england prim and proper lady and gentleman, sexual intercourse is a shocking necessity, but not something to be desired for cementing the love between a man and a woman. Her casual comment that “impotence,” a term she prefers is episodic and not very important. Her breathless expose is monumentally silly and undermines the seriousness of her critique against Pharma.

And dear Chris, you’re breathless fawning and credulousness is depressing, in itself. I think I’ll go take a prozac and pray your hard-nosed journalistic senses arise from their sleep.

By the way, I survive because of one her lifestyle drugs, called Provigil (Modafinal), which keeps me awake without having to rely on amphetimines. I have a lifestyle disease called narcolepsy.

Chris and Marcia, the human body is not a machine, the oil that works in a Ford should work equally well in a Chevy. But, the drug that works for Jones may not work for Peters, and all the large scale studies she quotes cannot account for that. Only caring observant doctors can.

The challenge of Big Pharma is real and grim, but stick to the issue and avoid the silly references to “studies” that do not study actual practice of real people.

Jack

(I have been up since 2:30 a.m., because I’ve been such a wreck about getting a manuscript ready and I couldn’t sleep.)

During the 1970s my father worked for a consumer product, over-the-counter concern that was affiliated with a pharmaceutical. He was endlessly frustrated that the scripts people could NEVER accept or acknowledge that business conducted outside of their “bubble” or protected sphere had only maybe half of the profit margin that they operated with. They have only built upon this denial of reality and have actually been supported and facilitated in this by the feds since the Reagan era.

Almost every student who worked at that same job with us was on either anti-anxiety or anti-depressant drugs.