Selling Sickness

How the World's Biggest Pharmaceutical Companies are Turning us All into Patients

Friday, September 02, 2005

Article in the Toronto Star: Pushing Pills down our Throats

By Judy Gerstel

Chances are, if you're an adult Canadian, that you're taking a prescription drug.

It could be a statin to lower bad cholesterol, an antidepressant to raise spirits, a calcium channel blocker to lower blood pressure, an erectile dysfunction drug to raise, er, ...

Last year, the cost of prescription drugs in Canada surpassed $18 billion.

That's a prodigious pile of pills.

It's also more than the payments for all services provided by all the physicians in Canada last year.

And the annual increase in prescription spending in this country — it's growing by $1.5 billion a year — would be enough to finance the services of some 3,500 new physicians every year, reports the Canadian Medical Association Journal.

Now that is hard to swallow.

And what's the explanation?

Are we getting sicker? Are we getting healthier? Or, are we simply getting suckered more by Big Pharma ...

A compelling case for the latter is made in a new Canadian book titled Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients.

Of course, author Alan Cassels, a drug policy researcher at the University of Victoria, and coauthor Ray Moynihan, a health care policy researcher and journalist, aren't exactly telling a new story.

Drug companies pandering to doctors and putting them on the payroll while at the same time medicalizing lifestyle issues is an oft-told, hoary tale.

Books have been written about disease-mongering and the sly marketing of non-essential medicines.

One of the most influential was published last summer: The Truth About the Drug Companies: How They Deceive Us and What To Do About It by Dr. Marcia Angell, former editor of the New England Journal of Medicine.

Cassels and Moynihan, however, while not focussing on Canada and mostly using U.S. dollar figures, include Canadian examples and resources and note differences between this country and its neighbour.

Cassels warns in his introduction that Canada's universal public health system "could be seriously undermined by the growing corporate influence (of the pharmaceutical industry) ... a health system that allows drug companies to play a role in defining who is sick," he writes, "is fundamentally unhealthy."

As Wall Street knows, he emphasizes, "There's a lot of money to be made telling healthy people they're sick."

The book devotes chapters to high cholesterol ("Selling to Everyone"), depression, menopause, attention deficit disorder, high blood pressure, pre-menstrual dysphoric disorder, social anxiety disorder, osteoporosis, irritable bowel syndrome and female sexual dysfunction — all of which have been (or, in the case of female sexual dysfunction, are in the process of being) turned into cash cows for Big Pharma.

Cassels and Moynihan take us behind the scenes, divulging strategies and manipulation — "dirty tricks and covert operations" — that cause a couple of disorders themselves: they make your skin crawl and make the hair on the back of your neck stand up.

One is what Cassels calls "the backdoor form of advertising known as `disease awareness' campaigns ..."

Another is bringing together panels of medical experts to alter the guidelines and definitions of medical conditions to make them more inclusive (thereby creating more patients and drug consumers) — for example, lowering the levels of cholesterol deemed necessary to qualify for treatment.

Eight of the nine experts who wrote the latest cholesterol guidelines also served as paid speakers, consultants or researchers to the world's major drug companies, reports Cassels.

My favourite, egregious pharmaceutical ploy is referred to as "astro-turfing" — creating fake "grass-roots" patient advocacy associations to promote disease awareness.

In a phone conversation, Cassels says the book could have been three times as long. "I could probably write a pharmaceutical scandal story a day," he says. He cites the use of neuroleptics for elderly people — "anti-psychotic drugs used willy-nilly to zombify our grandparents" — and the "in-your-face lobbying to politicians by the (drug) industry."

He accuses the Arthritis Society in British Columbia of being a "de facto marketing arm of Merck and Pfizer"(makers of Vioxx and Celebrex).

"We know that the industry bought credibility through the arthritis society," he says. "But the science wasn't there and people were duped big-time."

He also notes that a lot of the new patients taking Cox-2 drugs weren't seniors, that the drug companies "partly had to remake arthritis from being an older person's disease to something even a figure skater like Dorothy Hamill would get."

And just as an aside, Cassels points out that British Columbians take a lot fewer drugs than Ontarians. For example, he says, "We looked at cholesterol-lowering and came across this bizarre thing where the per capita rate for prescribing cholesterol-lowering drugs in Ontario is twice what is in British Columbia."

The reason? "No one really knows, but the West coast might attract people less likely to take drugs — the flaky, west coast thing — and also, the marketing of drugs happens most intensely in central Canada and the uptake is much faster and bigger in Ontario."

Cassels will be reading from Selling Sickness at the University of Toronto reading series at 7:30 p.m., Sept. 15, at Old Victoria College, 91 Charles St. W