Tell Your Doctor to Prescribe This

By Juan Matute

This reviews the practices of Big Pharma, focusing especially on the TV ads for medicines that we all know so well.  It (and other practices also) wastes money that could be much better spent on lowering costs to the consumer.  Again, a market dominated by Big Players needs to be regulated by the government in order that we have an economy that functions for the benefit of the consumer..

I am what is known as a retired senior citizen.   No longer in the jumble of traffic Telland editing of my schedule by my spouse.   Like many, I keep busy volunteering in community activities, participating in discussion groups, and a lot of time traveling.  I also spend time reading several media publications such as magazines, newspapers, online journalism, and books.  I’m also known to be an “intelligent aggregator” of articles, which I periodically pass online to over 140 readers.  Some of my time is spent watching TV news programming (MSNBC and CBS/NBC local and national news, which is typically viewed by older viewers).  While watching these programs I find myself subjected to the advertising of commercials for the targeted audience of those aged 51 and higher.   This is the ripe field for the pharmaceutical industry and the consumers who are the end users of their products, and that is the theme for this story.

Big Pharma is the phrase associated with the corporate groups that manufacture, market, and distribute medical products and drugs to consumers.   It is a giant industry which is supposedly regulated, but as all things BIG in our country, it is full of money and buys its way through the power of influence to pretty much do what it wants.   Much has been written and voiced about the abuses by the pharmaceutical industry to medical providers and consumers, and this story is no different.  Calling Big Pharma a form of an organized Mafia is not far from the truth; it is very powerful and lacking in transparency.   The United States is probably this most heavily medicated nation in the world, with almost 70% of the population on prescription drugs, and the rest using some form of OTC (over-the-counter) pills. 

To understand the business of the industry, we need to briefly grasp the trail from the manufacture of the drug through its journey to the consumers’ medicine cabinets.  Believe me, it is more complicated than the process of harvesting cocoa leaves in Colombia to a kilo of cocaine on the streets of any-town USA.  The medical research of a medicinal cure for an ailment or a disease begins in a laboratory with medical professionals in sincere research of a solution using chemical preparations.   There is an “AHA” moment when a cure is found, and now the job is to find a way to manufacture the drug and make it available to the sick.  This is where the process basically turns very ugly.  Over the course of years from the days when doctors like Joseph Lister and Louis Pasteur promoted sterile surgery, and the studies of Microbiology resulted in medicines steeped in the knowledge of bacteriology and virology, and up to more recent discoveries for curing Polio, we marveled and benefited from the work of brilliant doctors.   However, along with these great discoveries, the under-belly of Capitalism rose up with an infection that was attracted by the money to be gained by people who would pay good money to buy all these medical marvels.  This greed for the money to be made brought in the lawyers, the accountants, the patent attorneys, medical insurance companies, inducements and investment groups who would then own the process of developing and selling the drugs.  The marvels of medical invention created its own disease: BIG PHARMA.

In 2016, the total amount spent on prescription medicines in the U.S. was $450 Billion, and it is safe to estimate that 2017 is close to half a Trillion.   That is a lot of money, and here is a very brief list of the ways that each company employs tactics to ensure market share and increase profits:

  • Drug companies employ representatives to visit doctors’ offices to display, advise, and provide samples of their medicines to prescribe to patients.
  • Provide incentives to prescribe their medications to their patients (records are kept on this activity with doctors and pharmacies)
  • Pay doctors to have seminars with other doctors to advertise and endorse specific medicines or medical products.
  • Provide rebates to physicians who reach specific levels of prescriptions written for their products.
  • Host lunches and dinners for medical providers, sometimes even free trips and other inducements.
  • Arrange activities with PBMs (Pharmaceutical Benefit Managers) to prioritize their products for purchase by consumers through their employer or group medical plan. Yes - PBMs (Optum Rx, Express Scripts, etc.) were originally promoted to relieve insurance companies from having to deal with pharmaceutical companies, and now the PBMs are big players and just add another slice of the distribution process that works to take their cut in the business.
  • Agreements with hospitals and other health care providers that patients in their facilities use only certain medicines or products while in their facilities.

It was my own experience undergoing hip replacement surgeries that I became keenly aware of certain things that did not seem right.  First, my surgeon had to reschedule from one hospital to another because he was required to use the prosthetic implants specified by their hospital, whereas the surgeon performed his work at an alternate hospital that allowed him to use his preferred devices that they provided.   Next, while I was in recovery, I had brought my own medications to control blood pressure, but was told that I could not use them and had to take the same pills provided by the hospital (at great expense, I might add).  My attention to the protocols and procedures involving the revenue stream by medical providers was born.  

Later, I was struck by the marketing by Big Pharma directly to the consumer by advertising on television.   It was in 1962 that the Federal Drug Administration began to regulate the ads to prevent the release of false or misleading information.    It was not until 1983 that the first ad appeared on TV that marked the first direct marketing to the consumer.   Up until that point, pharmaceutical marketing was directed to the physicians.  The question of who was actually buying the prescription medications was answered – it was the consumer, and not the doctor. 

The barrage of advertising efforts was then started.   The 30 or 60 second ads on TV are slickly prepared, and the models in the ads are really much younger, smiling, and more beautiful than those who are actually the people who would benefit from the medicine.  Watching the ads makes you feel like your world would be a lot better if you took the pill.  The more sophisticated ads produce just enough required information about severe side effects or possibly death to claim that the information is not misleading, but it is the equivalent of the small print in a legal contract that is hard to absorb and pay attention as the soft and quickly mentioned narration passes by.  

The name given to the chemical formulary barely resembles the actual medical laboratory name.   Breezy and bold names are branded to the bio-chemical name, and there is no mention of price.   It is no wonder that that the pharmaceutical industry would like you to buy their medicines, because they cost a lot of money, and companies want to make more money.   All of these advertised products are patented, which means that they are the only ones who can make and sell the drug.   To be honest, some of these products do actually improve the quality of life, and benefit many people, but some are no better than an aspirin, a few prunes, and a glass of water to achieve the same result.  

For those drugs that are very beneficial, Big Pharma ensures that they will preserve their patented gem and change or tweak the formulation in such a way that they persuade the FDA that a generic product by another company cannot be made, and the FDA buys into the argument.  This tweaking of a patented drug continues as long as the originating company can make a ton of money.  In addition, the creation of a new drug does not have to prove that it is any better than any other drug already on the market, nor does the pharmaceutical company have to provide any results of testing that reflect negatively on the new drug.

The drugs that are advertised all have the same operative terms in one form or the other.   The direct marketing concedes that their product cannot be directly purchased over-the-counter like aspirin or Tylenol.  A prescription must be made by a licensed medical professional.   Each and every TV ad has the following notable words…”  TELL your doctor… ASK your doctor… TALK to your doctor”  or some other phrase about the consumer getting a doctor to write a prescription.   This direct marketing technique is blatant and ethically wrong.   There are only two nations in the entire world who allow this form of direct marketing, and it is New Zealand and the United States: no other country.  

Let’s first look at the cost for one to buy the drugs.  This is a list of drugs, advertised on TV during the preparation of this paper, which contain “tell, ask, talk” in the commercial messaging.    The first column is the brand name, followed by the targeted ailment, and then the cost of 90-days, and the annual cost.   There are 25 drugs listed, and as this piece is being written, new ones are appearing on TV, with brand new names.  It seems as though one end of the research lab has a boiler room full of creative people who are inventing new names that are vetted for eliminating offensive similarities to foreign languages, and conforming to dynamic excitement.   As soon as the brand name is ready, a messenger runs down the hallway to the research laboratory, where actual medical researchers are working and are told to invent a new drug because a name has been invented. The list of 25 drugs is on the last page.

There has been much written about the abuses by the pharmaceutical industry, and this piece is not intended to illustrate every category available by open source investigation.   Big Pharma is like the Big Banks of Wall Street.  Big and powerful, and loaded with money to tip the scales and influence on who is elected and what is legislated.  Regulation is desperately needed.  The FDA is weak, and the Consumer Finance Protection Bureau could assist, but something needs to curtail the abuses.   As with Big Tobacco and the Hard Spirits (booze) industry, those two have been regulated to prevent them from advertising.   The shameful advertising by Big Pharma compromises the Medical Profession and the doctors who actually prescribe medicine.  Going around the doctors and telling consumers that they need to follow what they have been told on TV is the shame of marketing directly to the consumer.   It almost seems as if the doctor needs to write a prescription just to keep the patient happy.   Also, the prescription is going to cost the patient and the medical insurance business a lot more money than needs to be spent.  All the money that could be redirected from direct consumer advertising could go to lower prices for medicines all around.   However, it needs to be realized that measures to regulate are always opposed by the same industry that is the target for regulation.

While writing this paper, it was reported that a group of doctors working on effective cancer treatment noted that the testing of a drug named Imbruvica  could be just as effective if the recommended pharmaceutical dosage were lowered, to save cost.  This news was not well received by the drug company, so it tripled the cost, to where it would be around $148,000 a year.  You might ask how and why they can do that.  The clear answer is that Big Pharma can.  My interest in writing this piece, as a consumer, is to add to the awareness that the abuse is an expensive waste of resources, and that it denigrates the doctors who should be the ones who determine what is best for their patients.  Regulatory reform is needed, and can only come about by direct consumer activism in changing the levers of power in Washington D.C.

 

DRUG NAME

PURPOSE

  90-DAY COST

 ANNUAL COST

Linzess

Gastroenterology

$3,858

$15,646

Humira

Musculesckletel & Rheumatology

$1.857

$7,533

Zarelto

Cardiovascular

$162

$657

Lyrica

Neurology

$175

$710

Tulicity

Diabetes

$112

$456

Otezla

Musculesckletel & Rheumatology

$1,223

$4,600

Xeljanz

Musculesckletel & Rheumatology

$19,598

$79,481

Brilinta

Cardiovascular

$3,715

$15,066

Harvoni

Antivirals

$5,912

$23,976

Eliquis

Cardiovascular

$175

$710

Vraylar

Psychotherapy

$918

$3723

Stelara

Antipsoriatic

$45,698

$185,330

Myrbetriq

Urological

$175

$710

Neulasta

Biotechnology

$26,174

$53,075

Chantix

Smoking Deterrent

$175

$710

Tujeo

Diabetes

$2,603

$10,557

Cosentyx

Antipsoriatic

$21,021

$85,254

Lunesta

Psychotherapy

$250

$1,013

Jardiance

Diabetes

$175

$710

Repatha

Cardiovascular

$463

$1876

Victoza

Diabetes

$175

$710

Enbrel

Musculesckletel & Rheumatology

$3,715

$15,066

Taltz

Psoriasis

$7,500

$82,500

Opdivo

Antinioplastic

$13,400

$54,340