Selling Sickness

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

Thursday, January 12, 2006

Book Review: BC Medical Journal

Book reviews

Selling Sickness. By Ray Moynihan and Alan Cassels. Vancouver: Greystone Books, 2005. ISBN 1553651316. Hardcover, 272 pages. $32.95.

This book is a must-read if you or your patients are concerned about the way the prescription drug business works. If you have wondered why the cost of medications in our system has gone from half to more than the cost of physician services over a decade, you’ll find some answers here. The writing style is journalistic without being sensational, has well-supported observations, and is an easy read.

There is a strong British Columbia connection since Mr Cassels is a drug policy researcher at the University of Victoria whom many of us have met or heard speak on drug issues. Some of the examples given in the book are very familiar, including references to activities of the Therapeutics Initiative, the work of some BC physicians, and several Pharmacare initiatives. Mr Moynihan is an Australian medical journalist who has written in the Lancet and the New England Journal of Medicine.

The focus is on the myriad avenues through which “big pharma” constantly influences every facet of medication use—marketing, regulation and policy, upward cost pressures, research, guideline development, and the seduction of physicians with money, peer pressure, prestige, and trinkets.

Serious questions are raised that our profession should be asking itself about the reluctance to establish stronger ethical boundaries with the pharmaceutical industry, regulation of financial relationships with sellers, acceptance of financial incentives, and frank conflict of interest. Material is drawn from several countries’ experiences and it reveals the cost of shrinking government support for research and evaluation; it leaves drug development to an industry that aims to fund only what might increase sales.

The chapter titles are descriptive: Selling to Everyone (Cholesterol, the Ads), Working with Celebrities (Menopause and the Public), Making Risks into Medical Conditions (Blood Pressure), Advertising Disease (Premenstrual Dysphoric Disorder), Taming the Watchdogs (IBS and the FDA), and so on.

The information in this book confirmed many things I had suspected. Physicians reading this book should recognize big pharma’s influence on the provision and cost of services and increased testing and office visits. The overlap from consumer advertising in the United States to the Canadian system and the number of patients sent to physicians’ offices specifically to request products they have been “sold” are further evidence of the industry’s sway.

The impact of siphoning billions of dollars away from other service needs, including physician services, and how we as a profession play a role in the uncontrollable rise in pharmaceutical costs are examined.

This is a timely book and I recommend it to anyone concerned about the bigger picture in health care. It makes clear that leaving our fate to the marketplace is risky and expensive and not necessarily a good thing for our patients’ health or our health care system.

—David Blair, MD