A particularly egregious example is the campaign for the HPV [human papilloma virus, which is associated with cancer of the cervix]. Personally, I think the vaccine is a good thing but I am very unhappy with the way it has been marketed to the public. The ads don’t tell you many things you need to know. They stress the fact that the infection is very common and that it is tied to sexual activity, but they don’t tell you that 70 percent of the people infected with the virus are able to clear it from their bodies spontaneously. Instead, they build this sense of urgency that you’ve got to get this to your kids while they are young, before they become sexually active, which is not true. Physicians can see this and understand the facts. But the everyday person hears the message from the drug company and feels that they have to run out and make sure that their ten-year old girl gets the shot immediately.
The Tragic Case of COX-2 Inhibitor Drugs
In your book, you wrote that the most expensive drug advertising campaigns in history were for the COX-2 inhibitor drugs like Celebrex, Vioxx and Bextra, which were marketed to the public as pain relievers that did not cause stomach upset or bleeding ulcers, which is a problem with aspirin or other anti-inflammatory drugs. You said that this claim was based on research largely funded by the drug companies themselves. Was the claim true? And how did these drugs work out over time?
As I detail in my book, the claim that COX-2 inhibitor pain relievers do not cause stomach upset was not true. Today, if you pick up the PDR [Physician’s Desk Reference], you’ll see warnings about gastrointestinal distress, illness and even fatalities caused by these COX inhibitors. Beyond the gastrointestinal distress that they promised you could avoid by taking these very expensive pills, there were strokes and heart attacks. These strokes and heart attacks were the ones I referred to earlier, which were deleted from the write-ups in the New England Journal of Medicine. The journal editors and reviewers of the articles weren’t told about the strokes and heart attacks at the time they ran the article. So the journal ran an article saying that these drugs were essentially safe and effective, when in reality they’re dangerous.
When drug or device companies are fined heavily (such as the $2 billion fine for Merck on Vioxx or the $500 million fine for Purdue on Oxycontin), do they still make a profit on the drug? Is this something they see as just a normal cost of doing business?
I’m not going to say that they always make a profit on that particular drug. It depends on the circumstances. If you look at Bextra, for example, where Pfizer ended up paying a $5.1 billion fine, that’s a huge amount of money. So it’s possible that they did not make a profit on that particular drug. But Pfizer made $44 billion that year. So one could assume for Pfizer, this is a cost of doing business. I have no way of knowing what the corporate executives are thinking; it’s unsupportable speculation. But I do point out that as huge as that fine is, their profits were even higher. I don’t think they really suffered in the end, despite the bad press about the people who were harmed by those drugs.
Ethical Issues for Paid Speakers and Ethicists
Drug companies and device manufacturers are among the major donors to bioethics institutes at the University of Chicago, University of Pennsylvania and University of Toronto, among others. Does this pose an ethical problem?
I think it does and I think it’s particularly insidious. Part of the problem here is that ethicists think of themselves, and in the vast majority of cases rightly so, as people who are dedicated to doing the morally right thing. Unfortunately, among some of them, there is this assumption that they cannot be bought. What makes this particularly insidious is that now that you’re dealing with people who honestly believe that they are beyond reproach, who honestly believe that they’re not doing anything wrong, who think, “My entire career is focused on morality and a few thousand dollars from a drug company is not going to change that.” I know that’s true because I think that way, too. I’m the first one to admit it. I don’t believe that it’s possible for a drug company to give me a few thousand dollars and change my opinion. And that’s what makes people especially vulnerable.
Because the changes in opinion or behavior are going on subconsciously and never rise to the level of conscious awareness?
Sometimes, because money can be seductive and some may find that their integrity has been gradually compromised. But there is another danger I perceived after I gave a talk for a pharmaceutical company some years ago. My talk was not any different from what I say to others. I had never before taken money from a drug company; I had always spoken without compensation. But this time I did. So I delivered my usual messages and although most people offered thoughtful feedback and some surprised me by agreeing with me, others did not like it. We had a positive and lively discussion.
The whole time, I was thinking, “There’s no problem, because taking the money is not changing anything I said.” I was hoping that some people would see my point and some did. But the more I researched this book, the more I began to question my perspective. Because what I began to understand is that sometimes the problem is not whether one’s opinions have been changed or corrupted; the problem can be the use the company makes of your statements.
More after the jump.