The Washington Post
Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugsby Melody Petersen
In the last thirty years, the big pharmaceutical companies have transformed themselves into marketing machines selling dangerous medicines as if they were Coca-Cola or Cadillacs. They pitch drugs with video games and soft cuddly toys for children; promote them in churches and subways, at NASCAR races and state fairs. They've become experts at promoting fear of… See more details below
In the last thirty years, the big pharmaceutical companies have transformed themselves into marketing machines selling dangerous medicines as if they were Coca-Cola or Cadillacs. They pitch drugs with video games and soft cuddly toys for children; promote them in churches and subways, at NASCAR races and state fairs. They've become experts at promoting fear of disease, just so they can sell us hope.
No question: drugs can save lives. But the relentless marketing that has enriched corporate executives and sent stock prices soaring has come with a dark side. Prescription pills taken as directed by physicians are estimated to kill one American every five minutes. And that figure doesn't reflect the damage done as the overmedicated take to the roads.
Our Daily Meds connects the dots for the first time to show how corporate salesmanship has triumphed over science inside the biggest pharmaceutical companies and, in turn, how this promotion driven industry has taken over the practice of medicine and is changing American life.
It is an ageless story of the battle between good and evil, with potentially life-changing consequences for everyone, not just the 65 percent of Americans who unscrew a prescription cap every day. An industry with the promise to help so many is now leaving a legacy of needless harm.
The Washington Post
The New York Times
Drug companies have institutionalized deception," said a former pharmaceutical executive at a 1990 Senate hearing. And former New York Timesreporter Petersen details these deceptions with information that will be startling even to those who closely follow the news on big pharma. Her subtitle, "How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs," is most effectively illustrated in a chapter detailing Parke-Davis's aggressive marketing of the epilepsy drug Neurontin "for everything," in blatant disregard of regulations against promoting drugs for uses not approved by the FDA. Such reporting, rather than style or analysis, is Petersen's strength. Much of what she recounts-such as the glut of copycat drugs like antacids, and marketers' lavish wining and dining of doctors-has been covered in books by others, like Marcia Angell. But Petersen fleshes out these issues and names prominent doctors who, she says, are on the take. She is particularly strong on the ghostwriting of medical journal articles by advertising agencies. She also covers less familiar matters, like the environmental impact of drug residues in water. There are quibbles; for instance, Petersen accepts without examination the bromide that most people take prescription drugs as a "quick fix." But she ends with tough, sound suggestions for reforms to make the pharmaceutical industry honest and to protect consumers. (Mar.)Copyright 2007 Reed Business Information
Justifying her sensationalist title with thorough documentation, award-winning business journalist Petersen, who spent four years covering the pharmaceutical beat for the New York Times , presents a truly disturbing book. Focusing on events within her home state of Iowa, Petersen describes the out-of-control trajectory of America's most powerful industry as it co-opts physicians with swag, subverts peer review and continuing education, turns cash-strapped university medical schools into corporate tools, and drains public coffers to pay exploding Medicaid-funded prescription costs. As a result, U.S. citizens face astronomical health-care and insurance bills, more than 100,000 deaths annually attributable to prescription drugs "taken as directed," and shortened life expectancies. As Greg Critser did in Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies , Petersen takes readers beyond glossy advertising and celebrity endorsements to glimpse the alarming dark side of the American pharmaceutical industry. If it cannot be found in doctors' offices beside old copies of Golf magazine, this work should certainly be available in all libraries. [See Prepub Alert, LJ 11/15/07.]-Kathy Arsenault, Univ. of South Florida Lib., St. PetersburgCopyright 2006 Reed Business Information.
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Our Daily Meds
How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs
By Melody Petersen
Farrar, Straus and GirouxCopyright © 2008 Melody Petersen
All rights reserved.
Once I thought I knew what disease was. It had seemed black and white. A person was either healthy or sick. Just the sound of the words of disease — cancer, diabetes, heart failure — could instill a sense of dread. Then I listened to the drug marketers and learned that the definition of disease was less certain. It was malleable, even slippery, in fact. A disease could be invented if one had the money, the power, and an adman's knack for salesmanship.
In January 2003 Neil Wolf, the vice president of a large drug manufacturer called Pharmacia, stood before dozens of pharmaceutical executives gathered at the Crowne Plaza Hotel in Philadelphia and explained the simple formula his company had used to create a disease. The public first heard word of this malady in 1998. News reports that year said it was a serious affliction, an epidemic, affecting as many as one in every four American adults. Mysteriously, the reports began just weeks before pharmacies were stocked with a new medicine for the disease, some white-colored tablets called Detrol. Now, five years later, in a hotel ballroom reserved for the Pharmaceutical Marketing Global Summit, Wolf was preparing to reveal the company's secrets and explain just how he and his colleagues had conceived and packaged this new ailment and sold it to the American public as if it were introducing a new car.
The Global Summit was one of the biggest annual events for pharmaceutical marketers. Outside the ballroom, dozens of vendors of drug marketing services were waiting in sales booths for their chance to woo the corporate executives. The creativity of these vendors had few limits. One firm offered the big pharmaceutical companies the chance to build tents shaped like giant pill capsules on the midways of auto races like the Indianapolis 500, where nurses would screen fans for whatever ills the drug company desired. In a booth farther down the aisle, another firm offered to promote prescription pills at the shopping malls it owned in thirty-six states. "The mall is the medium," the company proclaimed.
Many of the pharmaceutical executives attending the Global Summit were young, perhaps still in their twenties and not long out of college or an M.B.A. program. They had come to the conference to network and learn the secrets that would propel their careers. Many of them already knew part of the story of Detrol and eagerly waited to learn more.
As Wolf, a bearded man with graying hair, took the stage inside the ballroom, the audience quieted. The first slide of his presentation appeared on the large screen. It held the title he had selected for his speech: "Positioning Detrol (Creating a Disease)."
"We wanted people to see something in Reader's Digest," he said, "and go to the doctor and say, 'I have this condition.'"
When I began writing about pharmaceutical companies for The New York Times in early 2000, it was a time of exuberance and easy money on Wall Street. Stay-at-home mothers watched the cheery announcers on CNBC, the financial cable channel, keeping track of hot investment opportunities while hurrying their children off to school. Grandfathers withdrew money from savings accounts and bought stocks to boost their pensions. Middle managers quit their jobs to become day traders, buying and selling stocks using their home computers. Many start-up companies, with little more than a business plan of how they would make money through the Internet, saw their share prices rise by twenty to thirty times, even though they had never recorded a profit.
During this American boom it was the pharmaceutical manufacturers that most consistently excited market-crazed investors looking for fast growth with little risk. While the hot-selling technology companies held little more than a promise of sales in the future, the drug companies were succeeding in real time, making profits at more than twice the rate of the broader market, a feat they had accomplished for two decades. They weren't the high-risk technology companies they claimed to be. They made money even when the economy turned sour.
Selling medicines was an odd business. Disease meant money. Suffering brought profit. When I interviewed the pharmaceutical executives, I often heard something like this: "Our respiratory business is doing extremely well, as is our cholesterol business. The depression business has performed better than expected. Parts of that business are really growing strongly. It is the migraine market that is the problem."
The executives talked about their companies' medicines as if they were Hollywood producers about to release a new film. They spoke of "launching their next blockbuster," which they defined as a medicine that could bring in sales of one billion dollars or more in a single year. It was astounding to learn a company could earn so much from chemicals pressed into tablets. A billion dollars was enough in 2004 to send more than eighty-eight thousand American students to a public university, covering not only their tuition, but also their fees, room, and board.
My editors at the Times told me they wanted stories about the amazing new medicines these companies were discovering. But most of the products the executives boasted about were little different from those already being sold. AstraZeneca was developing a new cholesterol-lowering medicine, which would be the seventh entry in the class of drugs called statins. Executives at GlaxoSmithKline were talking about the company's new asthma drug called Advair, which was nothing more than a combination of two of the company's older medicines. The drugs had a new name and a fresh marketing campaign, but patients still had the same two drugs.
Then there were the companies that tried to extend their rich monopolies by introducing what they said were new and improved versions of products that had become wildly successful. Schering-Plough was preparing to sell Clarinex, which it said was even better than its bestselling allergy drug Claritin. Forest Laboratories brought out Lexapro, claiming it had beaten its star product, the antidepressant Celexa, in clinical trials. And AstraZeneca began selling its new "purple pill."
AstraZeneca had created pharmaceutical marketing history by focusing its promotion on the color of its product rather than on its name or even what it did. The pill's color had become a marketing tool, with the deep violet color giving it the feel of royalty and instilling loyalty in those who took it. According to industry consultants at IMS Health, AstraZeneca was one of the first drug companies to give their medicines unique shades to strengthen the value of their brand and public identity, just as Coca-Cola had done with the color red and the United Parcel Service with brown. Marketers were giving the pill a personality.
"Pink is perceived as calming, and may be suitable for heart drugs or tranquilizers, while bold colors such as red suggest rapid action and stimulation, and may therefore be appropriate for a painkiller or antidepressant," the IMS consultants wrote in an article in 2001. "On the other hand, it is difficult to imagine a pill in black, a color associated with death and morbidity."
If some patients did not realize their purple heartburn pill was actually AstraZeneca's Prilosec, then they did not notice as their doctors switched them to the "new" drug of the same shade but with the turn-ofthe-century name Nexium.
The introduction of products like Clarinex, Lexapro, and Nexium followed a pattern. The government approved them, and the first boxes left the loading docks just months before the patent protecting the company's older product expired. Once a drug's patent expires, generic manufacturers can sell the pills, and prices plummet. Scientists who were independent from the makers of these drugs published reports saying they could find no evidence that the new products were better than the old. The independent scientists urged patients to save money by taking the generic, but their advice was drowned out by the din of the new advertising campaigns.
In this profit-driven world of medicine, I did not often hear the executives talk of cures. The companies seemed to have little interest in getting to the bottom of what was actually causing cancer, heart failure, or diabetes. Instead, they focused like honeybees circling a picnic cake on products for what they called chronic disorders. These were drugs that did not cure but "managed" diseases as patients took them once a day for the rest of their lives.
It was investors who drove the companies' push to medicate America on a daily basis. Wall Street analysts grilled the pharmaceutical executives about their marketing campaigns during conference calls held every three months. Were they hiring more sales reps? When would that new advertising campaign that executives had promised begin? How many dinners had the company hosted for doctors? The financial analysts ranked the companies by the number of drugs they sold that had reached that golden benchmark of one billion dollars in sales in a single year.
One day I asked Daniel Vasella, the chairman of Novartis, how his company went about creating the blockbusters that investors demanded. He talked about how a company must first have a product that satisfied "an unmet need."
"Much of it is data-driven, information-driven," Vasella explained. "You create a desire."
Pharmacia called its new disease "overactive bladder."
Neil Wolf told the audience in Philadelphia that as the company was developing Detrol in the mid-1990s, executives decided they were not satisfied with their original plan to promote the drug as a treatment for incontinence. The market for drugs for people who accidentally wet themselves was small, he said. Many doctors believed incontinence was not a disease that should be treated with prescription medications but a normal part of aging that could be managed by changing one's habits. They suggested patients avoid caffeine and drink less fluid before bed or a trip to the store. Patients who nevertheless wanted a prescription drug could choose from an array of cheap medicines that had been on the market for decades and worked in a similar way to Detrol. With such low-priced drugs and doctors hesitant to prescribe them, the market for medicines for incontinence was worth just forty million dollars a year in the United States, hardly significant to the major pharmaceutical firms looking for their next big hit. This did not sway Pharmacia executives, however, who were determined to enter the market and shake it up.
At the time the executives were planning how to sell Detrol, the company had just gone through a difficult merger. Pharmacia AB of Sweden and the Upjohn Company of Kalamazoo, Michigan, had joined to form one company called Pharmacia & Upjohn. A bitter battle over turf and power still raged between executives on the two continents. Exhilarated by his appointment as chief executive, Fred Hassan, a Pakistan-born, Harvard-schooled chemical engineer, set out to show Wall Street that Pharmacia & Upjohn could create global markets for prescription drugs just like its much larger rivals. Detrol would be the new company's first test.
According to Wolf, the Detrol marketers were determined to take a drug that was considered "a niche product" and turn it into "a mass market opportunity." They decided they would not stop with their original plan to promote Detrol to the twelve million Americans believed to be incontinent. They dreamed of nearly tripling the size of the market. To do this, they planned to promote the drug to people annoyed by their frequent urges to use the bathroom. To expand the number of potential customers even more, the marketers said they would also tout Detrol to those who frequently acted on those urges and found themselves in the toilet nine or more times a day.
Wolf explained that people stricken with these overactive bladders were hindered by what he called "toilet mapping" and "defensive voiding." People who "mapped toilets" would not leave their homes, he said, until they knew the location of every clean facility in the vicinity of their planned travels. A person who used "defensive voiding," Wolf said, never passed a restroom without stopping in. Pharmacia hoped to make these frequent restroom users into its longtime customers by spurring an idea in their minds. Too much of their lives revolved around the toilet. Detrol, taken every day, would set them free.
Her hallucinations began soon after she started taking Detrol. They came only at night. She would wake up and talk with the apparitions, all of them family members who had long been dead.
Her memory also failed. After an examination, her doctor suspected the worst. He diagnosed Alzheimer's disease, an illness that means the beginning of the end. Alzheimer's horrifies patients and their families because it slowly robs people of their memories and their very souls. It can take a brilliant mind and reduce it to that of a helpless child. The woman's doctor reached for his prescription pad, giving her yet another medicine, this one called Aricept, which was supposed to slow the mental decline.
But the woman did not have Alzheimer's at all. Instead, Detrol had brought on the hallucinations and begun to steal her mind.
Pharmacia was hardly the first drug company to use marketing to create a disease. By the beginning of the twenty-first century, the process of expanding markets by creating new maladies had become almost mechanized within the pharmaceutical industry.
In 2003 Vince Parry, a pharmaceutical branding expert, wrote in the industry magazine Medical Marketing & Media that marketers were taking their ability to create new disorders "to new levels of sophistication." He called this process "the art of branding a condition."
Parry knew what worked to sell prescription drugs. He was the chief branding officer at in Chord Communications, Inc., a network of medical marketing companies with hundreds of employees.
"The idea behind 'condition branding' is relatively simple," he wrote. "If you can define a particular condition and its associated symptoms in the minds of physicians and patients, you can also predicate the best treatment for that condition."
Parry traced marketers' use of this technique back to the early twentieth century. He pointed to how the Lambert Company, which eventually became the drug giant Warner-Lambert, had greatly expanded the market for Listerine in the 1920s by creating public anxiety about a serious-sounding condition called halitosis. The word, which was first used around 1874, comes from the Latin word halitus. While it sounds like a dreadful malady that might cause death and suffering, it simply means having bad breath. In 1921 Gerald Lambert, the son of the company's founder, began a mass advertising campaign based on the word. The ads blamed halitosis for troubles ranging from a stagnant career to the failure to find a mate. The medical historian James Harvey Young wrote that Lambert increased Listerine's net earnings forty-fold through the ad campaign. The advertisements, he said, raised worries in readers' minds with slogans like this one: "You 5,000,000 women who want to get married: How's Your Breath Today?"
"This coined word frightened the continent," Young wrote, "not because bad breath was a fatal malady but because it was a social disaster."
Of all the categories of medical disorders, none is better suited for "condition branding," Parry explained, than the field of anxiety and depression. Because mental disorders are rarely based on measurable physical symptoms, he said, they are "open to conceptual definition." Many of the growing number of psychiatric conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, the primary reference for psychiatrists, were brought to light through funding by the pharmaceutical companies, Parry wrote. For example, few Americans had heard of an illness called panic disorder, he said, before Upjohn began marketing a drug called Xanax to treat it in the 1970s. Likewise, few people knew they could be suffering from something called generalized anxiety disorder if they worried too much until GlaxoSmithKline told them that a pill called Paxil would ease its symptoms. And in 2000 millions of women learned they might suffer from something called premenstrual dysphoric disorder, or simply PMDD. News reports of the disorder began just as marketers at Eli Lilly repackaged Prozac in a lavender and pink capsule, renamed it the sweeter-sounding Sarafem, and began selling it to treat this new disease. Lilly's television ads promoting the "new" drug showed a frustrated woman trying to untangle a shopping cart from a messy lineup of carts in front of a store. "Think it's PMS?" the announcer asked. "It could be PMDD."
Lilly's marketing methods did not work as well in Europe. In December 2003 European regulators forced Lilly to stop selling Prozac, also known as fluoxetine, for the premenstrual disorder, saying it was "not a well-established disease."
"There was considerable concern that women with less severe premenstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate use of fluoxetine," wrote Lilly executives in a letter announcing the regulators' decision to British doctors.
Excerpted from Our Daily Meds by Melody Petersen. Copyright © 2008 Melody Petersen. Excerpted by permission of Farrar, Straus and Giroux.
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