Bitter Medicine: Pills, Profit and the Public Health

Peter Jennings - ...Dr. Drummond Rennie is an editor at The Journal of the American Medical Association. He says researchers who are critical get attacked all the time. Do you actually believe, Dr. Rennie, that drug companies are intent on keeping the consumer on drugs, which are not as good as older drugs, for the simple requirement of profit?

Dr. Drummond Rennie - Yes. Yes, very much so. Absolutely. ....They've got to be prevented.

Peter Jennings - ... The top 10 drug companies combined made profits of more than $37 billion in the year 2001. And you, the taxpayer, are subsidizing research that benefits the drug industry.

...Nancy Chockley runs an institute funded by managed care organizations...

Nancy Chockley - What we found is that over the last 12 years, that there's really been a shift in the type of new drugs being approved by the FDA. And that we found that most of the growth was really in drugs that did not show any significant clinical improvement.

Peter Jennings - Eighty percent of the drugs which the FDA approves are not significantly different from the ones on the market already, and only 20 percent of the drugs are significantly new. Do you think the public even knows that? ...We're spending more on prescription drugs than we did in 1995. And the majority of the drugs approved by the FDA are simply modifications of old drugs...Consumers spend $90 billion more on prescription drugs last year than was spent just six years ago. And are we $90 billion healthier? ...But what critics call this 'gaming of the system' may have a much more damaging result.

Dr. Sharon Levine, Kaiser Permanente Medical Group - If I'm a manufacturer, and I can change one molecule and get another 20 years of patent life and convince physicians to prescribe and consumers to demand ... then why would I be spending money on a lot less certain endeavor, which is looking for brand new drugs?

Peter Jennings - The pharmaceutical industry has more registered lobbyists than the number of senators and congressmen combined.

Dr. Jerry Avorn, Brigham and Women's Hospital - I think there's a sense that, for example, when the FDA approves a drug, everything that needs to be known about it is known. I think patients believe that. I think doctors sometimes believe that. And that is not true.

Peter Jennings - How do you explain the overwhelming success of these drugs in a very short period of time?

Dr. Sharon Levine - I think the only explanation is the amount of money, the amount of time and energy that was put into promoting these drugs to doctors and advertising these drugs to consumers.

Peter Jennings - You see television ads like this all the time, including many on ABC News programs. They are part of the drug industry's $15 billion effort to get you to ask for particular drugs and to get doctors to prescribe those particular drugs. ...The drug companies spend vast amounts of money - nearly $3 billion selling to consumers, $5 billion marketing to doctors, $8 billion worth of free samples. ...Doesn't it make sense for the drug companies to at least educate the doctors about the prescription drugs that are available?

Dr. Marcia Angell - Well, that's not their business, education. Drug companies are not in the education business. Medical schools and teaching hospitals are. It's like expecting beer companies to educate people about alcoholism. It is not what they do.

Dr. Matt Handley, Group Health Cooperative - It's almost like a trade. You might not have the stomach problem, but the studies suggest you might, instead, be equally likely to have a more serious heart problem. ...I would personally wait years for long-term safety from the FDA's monitoring program before I'd consider taking them. If they were free, I would do that same thing.

Peter Jennings - What does this say about the social responsibility of the pharmaceutical industry? Or is the pharmaceutical industry supposed to have a social responsibility?

Dr. Sharon Levine - That's a very good question that the American people need to answer, do we want to entrust critical elements of the public health to an industry whose purpose, whose mission is to earn return for shareholders?

Peter Jennings - Congress has never required the FDA to routinely compare new drugs with older drugs. This is costing consumers billions of dollars that we do not need to spend. And in some cases, it could be costing lives. ...There is no law that says new drugs have to be proven 100 percent safe. ... The government says they must be relatively safe, which means that every drug comes with risks. And the result of that is that sometimes new drugs turn out to be more dangerous than old drugs.

Dr. Jerry Avorn, Harvard Medical School - If patients were aware of the limitations that all of us physicians have in terms of what we know and what we wish we know and what we don't know, they would be more scared than they are at present. ...The saying that a lot of doctors use sometimes in jest is, 'Always wait a year before prescribing a new drug. And if it's for a family member, wait five years.' And that's an awful thing to say, but it reveals a perception that we really don't know as much as we would like to know about a drug until it's been around.

Peter Jennings - The fact is, drugs can be used for years before we really know how safe they are. ...Dr. Drummond Rennie is an editor at The Journal of the American Medical Association. He says researchers who are critical get attacked all the time. Why do you think the industry is able to get away with what you have in the past called 'bullying tactics?'

Dr. Drummond Rennie, Journal of the American Medical Association - Money. Because if the shareholders are happy, whom else do they have to answer for? These are multinationals. They have no masters.

Peter Jennings - Can we trust studies funded by companies that have a vested interest in the results? ...Will the pharmaceutical industry do whatever it takes to get the results it wants from research?

Dr. Drummond Rennie - The temptation to spin those results is always there, and it's frequently used. Frequently.

Peter Jennings - For nearly every drug on the market, doctors must wrestle with conFL icting and sometimes inaccurate information.

Dr. Drummond Rennie - If only the good news about a drug is published, and never the bad news, then a false impression is given of the quality, effectiveness of that drug. It may be entirely false.

Peter Jennings - Does the drug industry, on occasion or regularly, suppress data?

Dr. Drummond Rennie - Oh, we suspect, and rather know, that this happens all the time.

Peter Jennings - Does the drug industry ever suspend a trial - a drug trial - because it believes the results will be different than it wishes?

Dr. Drummond Rennie - Yes, that's happened.

Peter Jennings - Does a drug company ever not publish the results of a trial because it doesn't like the results?

Dr. Drummond Rennie - Yes.

Peter Jennings - Do you actually believe, Dr. Rennie, that drug companies are intent on keeping the consumer on drugs, which are not as good as older drugs, for the simple requirement of profit?

Dr. Drummond Rennie - Yes. Yes, very much so. Absolutely. ... They've got to be prevented.

Peter Jennings - There is one last thing this evening which we believe is important for all of us. The questions about what we are getting for our money cannot and must not be answered only by the drug companies. Virtually everyone we talked to for this broadcast agrees on that. The rules by which this hugely profitable industry operates do not always serve consumers adequately. And nothing is going to happen, no matter how angry consumers get, unless the Congress and the president decide that the time is come. The country can do better. I'm Peter Jennings. Thank you for joining us. Good night.


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