The Drugs Don’t Work

Pfizer. Merck. GlaxcoSmithKline. Bayer. Bristol Myers Squibb. Roche. Eli Lillly. To name just a few.

These names are more familiar to some of us than others. They are certainly familiar to politicians. These multi-billion dollar pharmaceutical corporations are some of the most powerful corporations in the world, especially influential in the the United States. They wield an enormous amount of power, only some of which I can even touch on–it is a clever and convoluted industry.

I thought about comparing it to the Apple and Big Five publishing company price fixing scandal on eBooks, but then decided that wasn’t really serious enough. The price of an eBook being set wasn’t fair, it wasn’t ethical, and it was against the law. However, that decision didn’t affect peoples’ health, their mental or physical states, cause financial duress so severe those who own homes have to take out second mortgages to cover medical needs. Others scrape and scrimp and try to find money however they can.

This is not a diatribe against all the evils of the pharmaceutical industry. There are too many for me to go into, and I’m not well enough acquainted with the many different controversial areas they fall into to make educated comments anyway. I just want to mention a few things I do know and am familiar with, backed up by some actual figures.

First, though, what caused enough ire for me to even write a post about the pharmaceutical corporations? Ever since I’ve been aware of them, they’ve been up to no good under the guise of miracle workers.

They spend an astronomical amount of money on advertising. Why any government would allow pharmaceutical companies to advertise medication to a public who loves its medical shows and is somewhat a nation of hypochondriacs is beyond me. All of the ads end with, “Ask your doctor if such and such is right for you.” You end up with men asking their doctors about medicine for menopausal women. What an absolute crock! If the medicine was right for you, your doctor would tell you it was. And people wonder why the first thing a patient wants is a pill–“Just give me a pill, doc.” And many doctors are only too ready to comply. That’s what the representatives from the pharmaceutical companies want them to do. Sorry for the long quote–the references are at the end of the post:

In 2008, Senator Charles Grassley began an investigation about unreported payments to physicians by pharmaceutical companies. Grassley led a Congressional Investigation which found that well-known university psychiatrists, who had promoted psychoactive drugs, had violated federal and university regulations by secretly receiving large sums of money from the pharmaceutical companies which made the drugs.[57] The New York Times reported that Dr. Joseph Biederman of Harvard University had failed to report over a million dollars of income that he had received from pharmaceutical companies.[58] Weeks later, Business Week reported that Grassley alleged that Alan Schatzberg, chair of psychiatry at Stanford University, had underreported his investments in Corcept Therapeutics, a company he founded.[59] Dr. Schatzberg had reported only $100,000 investments in Corcept, but Grassley stated that his investments actually totalled over $6 million. Dr. Schaztberg later stepped down from his grant which is funded by the National Institutes of Health (NIH).[60] Similarly, Dr. Charles Nemeroff resigned as chair of the psychiatry department at Emory University after failing to report a third of the $2.8 million in consulting fees he received from GlaxoSmithKline. At the time he received these fees, Dr. Nemeroff had been principal investigator of a $3.9 million NIH grant evaluating five medications for depression manufactured by GlaxoSmithKline.[61]

The book Bad Pharma also discusses the influence of drug representatives, how ghostwriters are employed by the drug companies to write papers for academics to publish, how independent the academic journals really are, how the drug companies finance doctors’ continuing education, and how patients’ groups are often funded by industry.[62]

That tends to make the fish a little smelly. You can put a fish at the bottom of a huge pile of money, but it will still stink. What else have these companies been up to, other than bribing doctors to prescribe their products? How could I forget–fraud.

Antipsychotic drugs are now the top-selling class of pharmaceuticals in America, generating annual revenue of about $14.6 billion. Every major company selling the drugs — Bristol-Myers Squibb, Eli Lilly, Pfizer, AstraZeneca and Johnson & Johnson — has either settled recent government cases, under the False Claims Act, for hundreds of millions of dollars or is currently under investigation for possible health care fraud. Following charges of illegal marketing, two of the settlements set records last year for the largest criminal fines ever imposed on corporations. One involved Eli Lilly’s antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon; Pfizer settled that part of the claim for $301 million, without admitting any wrongdoing.[84]

On 2 July 2012, GlaxoSmithKline pleaded guilty to criminal charges and agreed to a $3 billion settlement of the largest health-care fraud case in the U.S. and the largest payment by a drug company.[85] The settlement is related to the company’s illegal promotion of prescription drugs, its failure to report safety data,[86] bribing doctors, and promoting medicines for uses for which they were not licensed. The drugs involved were Paxil, Wellbutrin, Advair, Lamictal, and Zofran for off-label, non-covered uses. Those and the drugs Imitrex, Lotronex, Flovent, and Valtrex were involved in the kickback scheme.[87][88][89]

The following is a list of the four largest settlements reached with pharmaceutical companies from 1991 to 2012, rank ordered by the size of the total settlement. Legal claims against the pharmaceutical industry have varied widely over the past two decades, including Medicare and Medicaid fraud, off-label promotion, and inadequate manufacturing practices.[90][91]

Company

Settlement

Violation(s)

Year

Product(s)

Laws allegedly violated
(if applicable)

GlaxoSmithKline[92]

$3 billion

Off-label promotion/
failure to disclose safety data

2012

Avandia/Wellbutrin/Paxil

False Claims Act/FDCA

Pfizer[93]

$2.3 billion

Off-label promotion/kickbacks

2009

Bextra/Geodon/
Zyvox/Lyrica

False Claims Act/FDCA

Abbott Laboratories[94]

$1.5 billion

Off-label promotion

2012

Depakote

False Claims Act/FDCA

Eli Lilly[95]

$1.4 billion

Off-label promotion

2009

Zyprexa

False Claims Act/FDCA

One of those drugs I still take, and three of them I have taken in the past. It was just as well with one of them–the fatal rash thing had me a bit on edge. It never happened, of course, but every little spot of red on my skin made me nervous, so I decided it just wasn’t worth the stress.

I never answered my own question, though. Why today to kvetch about the industry? I am, to put it bluntly, broke, except for the amounts I work out with my boyfriend, who is, bless him, being very patient through all this. I went to my pharmacy, the pharmacy I’ve been going to for the past 8 years, to pick up three prescriptions. I have insurance (also thankfully on my boyfriend’s insurance), which has good pharmaceutical benefits, for the most part. This would probably be a good place to mention that a name brand drug, let’s just take Prozac, since everyone generally knows it, only stays a name brand drug for a certain number of years before the proprietory patent runs out. When all there was available was name-brand Prozac, it was expensive, and with the tier system a number of health insurance providers set up, most likely a top tier drug–that is, more expensive than the generics. A drug becomes a generic when the patent runs out and all of the rest of the pharmaceutical companies pop out of the woodwork with their own version of the former name brand, generally known by it’s chemical formula. Prozac became fluoxetine, and the price dropped drastically. That is a major advantage of generics over the name brands–cost. I remember when I took Amerge for migraines, before it went generic, and it was $50 for nine tablets, after insurance. Because it was a top tier drug. So sometimes I would think, as best I could when I had a migraine, is this migraine worth $5.50, or should I just take a bunch of Advil and hope that works if I take a nap? I would get an average of three a month, sometimes four, so the $50 box would last 2-3 months. This was a PRN drug, something I took only as needed. Maybe it doesn’t sound like much, but I had other medications I had to take every day, and I had to pay for those as well. It adds up. Especially when you’re a student. It went generic, but it’s still one of the better medications for migraines, and I can’t take Imitrex. That was giving me rebound headaches so I had either a headache or a migraine every day. Insurance companies, spurred by the prices set by the pharmaceutical companies, made Amerge, known now by the generic name of naratriptan, a higher tier drug, so instead of $10, it was $25. Still cheaper than it had been, but the fact a generic was made a higher tier drug showed something a while ago that I should have paid closer attention to. The pharmaceutical companies were messing with the prices of generic drugs now. The next drug that became an issue after it became generic was Wellbutrin in its various forms, especially the extended release formula. Bupropion ER. It’s a popular drug, so prices were kept high on that one. Wait, supply…demand…no, the pharmaceutical world doesn’t work that way. The bigger the profit the better. Health insurance companies also made it a tier 2 drug, upping the price on it. Then, in a move of amazing stupidity that still leaves me incredulous, the health insurance company dropped the tier 2 placement of Bupropion, thankfully. For a while. They determined that a patient could only have one tablet a day of Bupropion ER. For some people, this wasn’t a problem. For people like me, however, it was. I take 450mg/day. There are no 450mg tablets, which means I have to take one 150mg tablet and one 300mg tablet. Two tablets. So the health insurance prognosticators are now psychiatrists with the ability to know my mental state and how much I should be taking of what drug. My pharmacy came up with a solution, so I get my medication, but (have you guessed what it is yet?) it sucks for me to have to pay for it. That’s right. Two prescriptions. One for 150mg tablets and one for 300mg tablets. They’re one tablet each, and they’re each for different dosages, so they’re not the same prescription. I can think of other things to say, but is that ridiculous or what? That was the last thing to happen, until today.

I was recently diagnosed with ADD, which was, I think exacerbated by the events of the past two years until it got to the point where I couldn’t compensate for it any longer. I needed to take something. I took the immediate release Methylphenid, four times a day, to see how it worked (generic for Ritalin). it was cheap. I had been taking it twice a day, but I couldn’t go all day without those two doses in the middle, so we decided to go with the extended release formula, the generic (take note of that, generic) form of Concerta ER. I took the prescription I received yesterday from my psychiatrist in to my pharmacy today confident I had enough to pay for everything. I had to wait for that one to be filled (you have to hand carry the prescription yourself for various reasons–it’s a controlled substance because it’s highly abused). I went to pay for them. Three prescriptions. I have better insurance now under my boyfriend’s insurance than I did on my own. The total was $53.19. I was a little in shock, partially because it took all the money I had in my wallet and then all the money I had on my debit card in my checking account to pay for it. One prescription was $8.00, the second was $7.77. I needed a pharmaceutical consult on the methylphenid ER because I haven’t taken it before, and that was when I saw the price on it–$37.42. I was astounded. The other one had been so inexpensive, I hadn’t expected this one to be nearly thirty dollars more. When I found out why, I was completely disgusted.

Apparently, the pharmaceutical companies got together earlier this year, sometime between April and June. Now that this drug has gone generic, they weren’t making as much money. Children and adults are being diagnosed with ADD or ADHD left and right these days, and being prescribed medications, and this one is a fairly popular one.

What better way, they decided, to increase the profits than to create a shortage of the medication to drive the price up.

My source for this was equally disgusted the government hadn’t done anything about this, but then again, she said, they couldn’t balance a budget, either. The Food and Drug Administration, so called because they are supposed to be paying attention to potentially dangerous and illegal issues with food and, well, drugs, are in charge–overseers of the pharmaceutical agencies. Have the Mercks and Pfizers done so many heinous things that they’re just overlooked? The FDA and the Department of Justice look the other way and allow things like this to happen?

Or, is it the fact that the pharmaceutical industry has one of the most powerful groups of lobbyists in Washington, D.C.?

To help ensure the status quo on U.S. drug regulation and pricing, the pharmaceutical industry has thousands of lobbyists in Washington, DC that lobby Congress and protect their interests. The pharmaceutical industry spent $855 million, more than any other industry, on lobbying activities from 1998 to 2006, according to the non-partisan Center for Public Integrity.[68]

methylphenid 36 stock-footage-production-line-for-tablet-pill-sorting-and-packaging-hd-p Closeup Money rolled up with pills falling out, high cost, expensive healthcare

One of the unfortunate side effects, no pun intended, is that it’s the pharmacies who get the blame, when they have nothing to do with it. They simply sell the prescriptions they’re given, at the cost they have had to buy the medication at in the first place, and the price is after whatever insurance has chosen to cover. Don’t blame them–they’re as frustrated as you are. Put the blame where it truly belongs, on the pharmaceutical industry. Don’t kill the messenger. Trust me, whatever the pharmacists at your drug store are making, it’s a drop in the bucket compared to what the CEOs and CFOs and any other higher ups you can think of are taking home in a year at GlaxcoSmithKline.

Governmental agencies are supposed to be working for the people. As we’ve seen lately, some parts of the government don’t seem to be paying too much attention to what they’re supposed to be doing. The FDA is not living up to its responsibilities as a protector for the people, to make sure that they are safe from things such as price fixing or quantity control. It very possibly is time for another agency, such as the DoJ, to step in and take a look around. Fines don’t mean anything to people who have money to burn.

Does the paper money is made out of burn at 451 degrees, or do the special things in it to make it difficult to counterfeit change that? Just one of those odd thoughts I get at times. When you’re a multi-billion dollar corporation, what does a fine of $301 million dollars mean? Less to them than the $37.42 meant to me.

I wish I could think of some witty or clever way to end this, but I think I may be more saddened now than I was when I started. Think of what people who wield such power have the ability to do, yet look what they choose to do instead. It is true. Absolute power corrupts absolutely.

"Off with her head!" by Arthur Rackham

“Off with her head!”
by Arthur Rackham

57.   Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. p. 21.

58.   Harris, Gardiner; Carey, Benedict (June 8, 2008). “Researchers Fail to Reveal Full Drug Pay”. The New York Times.

59.   Weintraub, Arlene (June 26, 2008). “Drug Makers and College Labs: Too Cozy?”. Business Week.

60.    “Stanford Researcher, Accused of Conflicts, Steps Down as NIH Principal Investigator”. The Chronicle of Higher Education. August 1, 2008.

61.    Gellene, Denise; Maugh II, Thomas H. (October 4, 2008). “Doctor Accused in Congress’ Probe”. The Los Angeles Times.

62.   Bad Pharma, pp. 274, 287, 303, 311.

   68.  “Senators Who Weakened Drug Bill Got Millions From Industry,” USA Today, May 10, 2007

 84.  Duff Wilson (October 2, 2010). “Side Effects May Include Lawsuits”. New York Times.

85.   “GlaxoSmithKline”. 4 July 2012.

86.   “GlaxoSmithKline Agrees to Pay $3 Billion in U.S. Drug Settlement”. 2 July 2012.

87.   Fred Mogul (2 July 2012). “NY to Get Millions in GlaxoSmithKlein Settlement”. WNYC. Retrieved 2 July 2012.

88.   “BBC News -GlaxoSmithKline to pay $3bn in US drug fraud scandal”. BBC Online. Retrieved 2 July 2012.

89.  Thomas, Katie and Schmidt, Michael S. (July 2, 2012). “Glaxo Agrees to Pay $3 Billion in Fraud Settlement”. The New York Times. Retrieved July 3, 2012.

90.  Sammy Almashat, M.D., M.P.H., Charles Preston, M.D., M.P.H., Timothy Waterman, B.S., Sidney Wolfe, M.D., Rapidly Increasing Criminal and Civil Monetary Penalties Against the Pharmaceutical Industry: 1991 – 2010, Public Citizen’s Health Research Group, December 16, 2010

91.  http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay-3-billion-in-fraud-settlement.html?pagewanted=all

92.  USDOJ: GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data

93.  http://www.justice.gov/usao/ma/news/Pfizer/Pfizer%20-%20PR%20(Final).pdf

94.  USDOJ: Abbott Labs to Pay $1.5 Billion to Resolve Criminal & Civil Investigations of Off-label Promotion of Depakote

95.  #09-038: Eli Lilly and Company Agrees to Pay $1.415 Billion to Resolve Allegations of Off-label Promotion of Zyprexa (2009-01-15)

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