by Franklynn Bartol
Much of the public discourse around Big Pharma’s quest for profit has focused on unaffordable drug prices. Recent investigations even suggest that billions of dollars of pharmaceuticals are wasted every year due to pharmaceutical packaging purposefully designed to make hospitals and patients buy more than they need:
However, inflated price tags are just one of the pharmaceutical industry’s strategies for maximizing profit. Scholars, activists, and health professionals are also calling out industry influence on the prescription process itself.
In the case of Tamiflu, there was an urgent demand for better influenza treatments to address impending pandemics — Roche had a ready-made market for their antiviral. However, there are also cases in which the industry creates the ‘demand’ for their ‘supply’.
It does so in two ways: 1) promoting the prescription of multiple drugs for longer periods at higher doses and 2) creating ‘problems’ to be ‘solved’ by pushing new diagnoses.
The industry exerts these market-expanding influences at all levels of supply and demand: public health regulatory bodies, health professionals, and patients. This post will discuss how the industry influences everyday healthcare decisions about diagnosis, drugs, and dosages by ‘educating’ health care workers and patients.
Expanding the Market: Higher Doses, New Diagnoses
Pharmaceutical companies expand the market for their products by convincing doctors and patients to equate good health with taking more drugs. A culture of perpetual risk and perpetual treatment is created by pharma marketing messages and ‘educational’ initiatives, ensuring a constant and increasing demand for more drugs.
Academic and journalist Ray Moynihan discusses this issue in his Ted Talk ‘Too Much Medicine’. He provides examples of the “broadening of disease definitions” and the “medicalization of everyday life” by which pharmaceutical companies not only expand the market for their products but create new markets altogether by redefining common experiences as treatable health conditions.
The most profitable drugs are ones for which large portions of the population are long-term customers. This motivates drug companies to promote diagnoses that would result in this large consumer base.
Gender Studies scholar Thea Cacchioni researches the pathologization of sexuality and pharmaceutical companies’ role in promoting the diagnosis ‘Female Sexual Dysfunction’ (FSD). Her book ‘Big Pharma, Women and the Labour of Love’, along with Moynihan’s investigation ‘Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction’, reveal the industry’s concerted effort to widen the diagnosis FSD to include nearly half of all women.
Pharma companies established the legitimacy of FSD through educational campaigns training doctors to diagnose the condition and marketing campaigns to ‘educate’ women, targeting leading women’s health advocates. Despite its unproven impact on libido and strong warnings from scientists about roofie-like side effects, a ‘pink viagra’ pill was passed by the USFDA under pressure from industry-backed doctors and women’s health advocates convinced of its necessity.
In this case, as in many others, health professionals’ genuine concern for their patients was co-opted by pharmaceutical companies to help push unnecessary, and even harmful, drugs.
For more coverage of ‘overprescription’ see the British Medical Journal’s “Too Much Medicine” Initiative and the Lown Institute’s reports on “Medication Overload”
Targeting Healthcare Workers
It’s no secret that drug and medical device companies specifically target doctors in their marketing strategies. Forest Laboratories illegally paid doctors to prescribe and promote its antidepressants Lexapro and Celexa. The marketing plan was made publicly available by the U.S. Senate during a civil lawsuit against Forest Laboratories. The plan included $34.7 million to pay 2,000 psychiatrists and physicians to deliver 15,000 marketing lectures to their colleagues.
While still ongoing, pharmaceutical marketing to physicians has come under increasing scrutiny, leading to tighter legal restrictions and transparency requirements for disclosing financial ties. However, other healthcare workers remain unprotected by many marketing regulations.
A common assumption is that marketing to non-prescribing healthcare workers is inconsequential.
Dr. Quinn Gundry’s groundbreaking research is challenging this idea by revealing the central role of nurses in administration and purchasing decisions. Gundry is Assistant Professor of Nursing at the University of Toronto and member of the WHO’s Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector.
As a registered nurse, Gundry witnessed first-hand the unique pressures nurses face as targets of medical sales reps. Her book ‘Infiltrating Healthcare: How Marketers Work Underground to Influence Nurses’ describes the normalized presence of sales reps in operating rooms, on purchasing committees, and patient care units where sales reps exert their influence through ‘medical education’, ‘product support’, gifts, free samples, and invitations to industry-sponsored events.
She argues that the important role of educating healthcare workers about medical products should not be provided by industry employees and advocates for the removal of profit-motivated work from healthcare spaces.
Targeting Patients and Advocates
Industry influence doesn’t stop at healthcare professionals. Patient advocacy groups provide much-needed patient- and caregiver-focused education, advocacy, and support services. Advocacy groups often lobby the government to influence health policy and research agendas, making them a valuable target for pharmaceutical companies.
While industry funding of patient advocacy groups is not universal, it is certainly commonplace, with concerns being raised across North America, Europe, and Australia. A recent report on patient advocacy groups in the U.S. revealed that at least 8 in 10 groups receive industry funding, with an average of one third having an industry executive on their board.
While it is not legally required in the U.S. for patient advocacy groups and pharmaceutical companies to disclose their financial ties to one another, you can see these relationships on Kaiser Health News’ database ‘Pre$cription For Power’.
Pharmaceutical companies are eager to offer funding, drug information, and advice in exchange for opportunities to market to patients, build relationships with key opinion leaders, coordinate lobbying for drug access and subsidies, recruit clinical trial participants, and enhance their credibility (Parker et al., 2019).
These partnerships have real impacts on advocacy: industry-funded groups are more likely to take positions that are financially favourable to their industry sponsor (Fabbri et al, 2020). This can have devastating consequences, as seen in the current opioid crisis, in which pharmaceutical companies paid millions of dollars to patient advocacy groups to promote pain medications and lobby for reduced restrictions on opioid use.
While it may sound counterintuitive for health-focused advocates to partner with profit-focused companies, many patient groups feel they have no choice. In her book Health Advocacy, Inc. How Pharmaceutical Funding Changed the Breast Cancer Movement, health activist, scholar, and cancer survivor Sharon Batt reveals how reductions in government funding forced Canada’s formerly grassroots breast cancer advocacy groups to partner with Big Pharma, resulting in a movement that now puts industry interests ahead of public health.
In many ways, patient advocates are simply responding to the capitalist forces structuring their access to care. This explains why recently 28 patient advocacy groups tried (unsuccessfully) to stop Health Canada from lowering drug prices. They argued that pharmaceutical companies will no longer invest in Canadian drug research and production if it’s less profitable, echoing warnings from the pharmaceutical industry itself.
Resisting the Industry to Put Public Health First
If this sounds dire, there are ways to stay informed and advocate. Many pharmacists, physicians, researchers, and other healthcare workers are leading the way in calling out profit-based influence on clinical decision-making. This includes educational campaigns to inform both patients and healthcare workers about pharma marketing practices, such as Dr. Adriane Fugh-Berman’s ‘Pharmed Out’ initiative at Georgetown University.
When physicians find that overprescription has occurred, an emerging deprescription movement provides research, advocacy, and best practices for safely ‘deprescribing’ patients from unnecessary or harmful drugs.
Canadian pharmacist James McCormack, has even taken his musical talents to Youtube to raise awareness, producing educational song parodies such as Like a Bridge Overdiagnosis.
There are also ways for patients to get better healthcare information. Public Citizen publishes evidence-based, industry-independent second opinions on pharmaceuticals and supplements, noting side effects and interactions that may not be included on product labels.
Medications aren’t the only products suffering from an interest in profit over patient care: poorly researched medical devices have had devastating health consequences for many patients (for an entertaining, if troubling, foray into this issue, watch the recent feature on medical devices on Last Week Tonight with John Oliver).
Luckily, the International Consortium of Investigative Journalists maintains an Medical Devices Database that gives “patients access to more than 120,000 records about faulty or even dangerous medical devices from around the world”.
Healthcare workers, researchers, and patient advocates are working hard to expose and counteract industry influence on everyday medical care. But they shouldn’t have to. Clinicians should be free to practice in their patients’ best interests, not industries’.
Patients should receive medical care driven by scientific evidence, not marketing. Until governments act to remove corporate actors from medical education and practice, clinicians and patients are forced to continue their fight for care over profit.