Drug companies “make and sell a lot of extremely effective, safe and valuable medicines, which extend life and reduce suffering.” Medicines Australia, Annual Report 2002

Drug companies “make and sell a lot of extremely effective, safe and valuable medicines, which extend life and reduce suffering.” Medicines Australia, Annual Report 2002 Ray Moynihan, Australian Financial Review

While many drugs can reduce suffering and extend lives, drug promotion can be poisonous

While many drugs can

reduce suffering and extend lives,

drug promotion can be poisonous

“Creating the need” is one of the pharmaceutical industries key promotional strategies

“Creating the need”

is one of the pharmaceutical industries

key promotional strategies

How curious! The drugs and the disease are made by the same people!

Potential Conflict Public Interest: rational use of medicines Pharma Interest: maximum use of medicines

Public Interest: rational use of medicines

Pharma Interest: maximum use of medicines

Problems with pharma promotion Drug promotion: can lead to inappropriate use, costly and dangerous Disease promotion: ordinary life becomes disease, healthy people turned into patients

Drug promotion: can lead to inappropriate use, costly and dangerous

Disease promotion: ordinary life becomes disease, healthy people turned into patients

Drug promotion examples Hormone replacement therapy slightly increases risk heart attacks, strokes, cancer (long term use) Rossouw JE, et al, JAMA, 2002, 288, 321-33 Anti-arthritis drugs (cox-2s) increase risk heart attacks (not necessarily a class effect) Chen LC, Ashcroft DM, Pharmacoepidemiol Drug Saf., 2007, 16:762-72 Anti-depressants associated with slightly increased risk of suicidal behavior Healy D, Aldred G, Int. Rev. Psychiatry, 2005, 7, 163-72

Hormone replacement therapy slightly increases risk heart attacks, strokes, cancer (long term use) Rossouw JE, et al, JAMA, 2002, 288, 321-33

Anti-arthritis drugs (cox-2s) increase risk heart attacks

(not necessarily a class effect) Chen LC, Ashcroft DM, Pharmacoepidemiol Drug Saf., 2007, 16:762-72

Anti-depressants associated with slightly increased risk of suicidal behavior Healy D, Aldred G, Int. Rev. Psychiatry, 2005, 7, 163-72

Disease promotion examples Osteoporosis: risk factor made into disease Social Anxiety Disorder: widening boundaries of disease Female Sexual Dysfunction: creating new disease

Osteoporosis: risk factor made into disease

Social Anxiety Disorder: widening boundaries of disease

Female Sexual Dysfunction: creating new disease

Disease promotion examples Osteoporosis: risk factor as disease 1994: WHO defines osteoporosis = 30% of older woman suffer “disease” 2007: “pre-osteoporosis” = 50% of older women, 200 million have “condition” International Osteoporosis Foundation activities sponsored by companies Alonso P, Guyatt G, Moynihan R, BMJ, 2007, (in press)

Osteoporosis: risk factor as disease

1994: WHO defines osteoporosis = 30% of older woman suffer “disease”

2007: “pre-osteoporosis” = 50% of older women, 200 million have “condition”

International Osteoporosis Foundation activities sponsored by companies

Alonso P, Guyatt G, Moynihan R, BMJ, 2007, (in press)

Disease promotion examples Social Anxiety Disorder (SAD): widening boundaries of disease PR firm Cohn & Wolfe “raise awareness” about disease before Paxil approved Cohn & Wolfe specialise in “cultivating the marketplace prior to approval” “ Information” campaign says “1 in 8” suffer SAD- shyness as a symptom of disease GSK funded PR campaign explicit aim to boost sales of GSK’s Paxil Cohn & Wolfe won PR industry awards for campaign – “astro-turfing”

Social Anxiety Disorder (SAD): widening boundaries of disease

PR firm Cohn & Wolfe “raise awareness” about disease before Paxil approved

Cohn & Wolfe specialise in “cultivating the marketplace prior to approval”

“ Information” campaign says “1 in 8” suffer SAD- shyness as a symptom of disease

GSK funded PR campaign explicit aim to boost sales of GSK’s Paxil

Cohn & Wolfe won PR industry awards for campaign – “astro-turfing”

Disease promotion examples Female Sexual Dysfunction (FSD): creating new disease Key medical meetings to define FSD sponsored by drug companies 18 of 19 authors of new FSD definition disclose financial ties to companies Company linked researchers claims 43% of women suffer FSD Moynihan R, Making of a disease, BMJ, 2003,326, 45-7

Female Sexual Dysfunction (FSD): creating new disease

Key medical meetings to define FSD sponsored by drug companies

18 of 19 authors of new FSD definition disclose financial ties to companies

Company linked researchers claims 43% of women suffer FSD

Moynihan R, Making of a disease, BMJ, 2003,326, 45-7

Promotion Targets Three Groups Professionals Patients Public

Professionals

Patients

Public

Promotion Targets Three Groups The spin Professionals: drug companies “educate” doctors Patients: drug companies “partner” with patients Public: drug companies “inform” the public

The spin

Professionals: drug companies “educate” doctors

Patients: drug companies “partner” with patients

Public: drug companies “inform” the public

Promotion Targets Three Groups The reality Professionals: education becomes skewed to latest drugs Patients: patient groups become advocates for drugs Public: misleading advertising disguised as information

The reality

Professionals: education becomes skewed to latest drugs

Patients: patient groups become advocates for drugs

Public: misleading advertising disguised as information

What to do about drug promotion? Discover Disclose Disentangle

Discover

Disclose

Disentangle

What to do about drug promotion? Discover: investigations, commissions, inquiries into corrupt relationships Disclose: comprehensive and mandatory disclosure of ties & sponsorship Disentangle: criminalize bribes, reduce sponsorship, more independent voices

Discover: investigations, commissions, inquiries into corrupt relationships

Disclose: comprehensive and mandatory disclosure of ties & sponsorship

Disentangle: criminalize bribes, reduce sponsorship, more independent voices

Drug companies “make and sell a lot of extremely effective, safe and valuable medicines, which extend life and reduce suffering.” Medicines Australia, Annual Report 2002 Ray Moynihan, Australian Financial Review

More references for presentation Moynihan R, Too Much Medicine? , ABC Books, Sydney, 1998 Ray Moynihan & Alan Cassels, Selling Sickness , Allen & Unwin, 2005 (translated into more than a dozen languages) www.healthyskepticism.org

More references for presentation

Moynihan R, Too Much Medicine? , ABC Books, Sydney, 1998

Ray Moynihan & Alan Cassels, Selling Sickness , Allen & Unwin, 2005 (translated into more than a dozen languages)

www.healthyskepticism.org