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Governments are increasingly made uneasy by conflicting impulses surrounding the drug industry. It used to be that they couldn't live without the industry. Now they are realizing that they cannot live with it either.

Governments are increasingly made uneasy by conflicting impulses surrounding the drug industry. It used to be that they couldn't live without the industry. Now they are realizing that they cannot live with it either.

A recent British House of Commons report, The Influence of the Pharmaceutical Industry, illustrates this. The British, like many governments, are struggling to pay for increasing consumption of expensive drugs and also for the "distress, ill-health, hospitalization, and even death" caused by them. Adverse reactions to drugs cause about 5 percent of hospital admissions in the UK and a larger portion of total hospital costs.

Motivation

Pharmaceutical companies generate a huge amount of economic activity, but their focus is increased sales, not increased health. Marcia Angell, former editor of the New England Journal of Medicine documented in her book (The Truth about the Drug Companies, Random House 2004) that profit margins usually far above general industry norms arise only from drugs on which they have a sales monopoly.

Method

The UK Health Committee heard testimony about clinical trials being skewed to benefit a new drug. Trial results are generally favourable when the sponsor is a drug company, according to a 2003 report in the Journal of the American Medical Association (JAMA), and according to the Alberta Research Centre for Childhood Health Evidence, unfavourable results often go unpublished or are buried in an obscure journal. In addition, JAMA (1998) reported that promotional material may be disguised as a scientific paper for high-profile scientists to sign, even though they may not have read the paper.

Market

Once a drug is approved, the marketing machine often showers doctors with simplified (and possibly biased) drug information, free samples, and perks, such as free meals or even trips to company-sponsored conferences. In 2000 it was estimated that drug companies were spending about $10,000 per year on marketing to the average US physician. Doctors may even be deliberately involved, enrolled as consultants with no responsibilities, or encouraged to sign up patients for clinical trials for which they will be richly compensated.

Marketers also now focus on "disease awareness" campaigns, advertising a disease created by them for which there is only one approved drugtheirs. According to Graham Vidler, a British consumer advocate, people are encouraged to "Go and see your GP. Be forceful. There is something that can be done." The GP has already been primed to prescribe the right drug when asked. Campaigns are often promoted by an association with a name like "Depression Alliance" that obscures its reliance on funding from a drug company.

Message

Despite all the damaging information that this committee compiled, it eventually retreated to the conclusion that the current system just needs slight adjustments. Recommendations to provide more transparency in drug approval and doing more research into drug safety and adverse effects are welcome, but it is far from sure that any major government will have the courage to distance itself from such a financially powerful and politically savvy industry. Do your own research, and try the least risky approach to health problems first.

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