November 20th, 2005
Take Your Pills, Ignore Your Belly
By Greg Critser
Los Angeles Times
Last week, stock market analysts parsed the latest sales reports from the nation’s biggest drug companies in search of why profits in the normally high-performing industry have plummeted. Good luck finding anything new.
Pharma chief executives offer up only the usual culprits: generic competition, overzealous regulators, trial lawyers, bad public relations and the high cost of discovering new drugs.
But one place to look for the real answer is right in front of our eyes and, increasingly, in our bellies. It’s the pills. As my nephew might say, they suck in a major way. They’re neither as effective nor as safe as we are led to believe.
That’s because only about half of pharma’s products launched since 1990 represent clinically significant improvements over older, cheaper products — and that’s the positive spin from pharma’s own think tanks.
Worse, problems from side effects are soaring — particularly as one in six Americans now take three or more prescription drugs daily, usually in combinations never even tested on animals. No wonder pharma earnings are in the tank. The patient is sick of being the lab rat. And that’s one big reason why only about half of patients stay on any given regimen, a definite bummer for prescription renewals and thus sales.
Big Pharma’s response? Denial and deflection.
The deflection comes in the form of a huge, over-the-top ad blitz touting the industry’s new cancer drugs — despite the fact that most of the handful of truly breakthrough oncology drugs came not from Big Pharma but from biotech upstarts. Thus a Norvartis ad in last week’s New Yorker magazine featured a patient telling us that "Novartis drove my cancer into remission in 56 days," with, of course, a minuscule disclaimer that no cure is being claimed.
Why, then, the blitz? To get across the crybaby capitalist idea that we shouldn’t criticize pharma too much. That notion was explicitly stated a month ago by a pundit from the pharma-sponsored American Enterprise Institute who, countering a blistering critique of the industry on "Real Time with Bill Maher," shouted: "But they’re curing cancer!" That line has migrated to other pro-industry pundits, such as Tucker Carlson, who a few weeks ago countered another critic by shouting: "Wow, I hope you don’t get cancer, man." Call them the cancer nannies.
The denial of the bad-product problem comes from one of the fastest-growing divisions within Big Pharma these days. It has nothing to do with R&D but with what the industry likes to call "persistence and compliance." In short, a persistence-and-compliance executive tries to figure out how to keep a patient on a pill — even if the patient doesn’t like it. Pharma has invented, yes, corporate nannying!
Often, P&C programs are run in partnerships between HMOs and pharma. The hectoring comes via phone calls or e-mails to patients from a "health counselor" (P&C reps). But increasingly, P&C reveals itself for what it is: marketing. Consider the riffs of Ray Sacchetti, the P&C chief at Bristol-Myers Squibb. In a study of what he calls "adherence marketing," Sacchetti told industry marketers that he could prove that direct-to-consumer, or DTC, ads could increase compliance. "If you do 160 days of DTC, you get a 35% rate of compliance in 12 months," he said. "But if you do 250 days of DTC ads, you get 65% compliance!" Wow, and we thought we were just getting an idiotic ad.
What does all this mean? It means huge amounts of money are spent getting us to take our pills — and shut up while we’re doing so — while less and less is being spent to discover pills we really need. That’s pharma’s right in our free market system, but P&C can also harm patients by encouraging them to keep taking a drug that may be harmful. Such was the case with many programs designed to increase compliance with pain relievers (Cox-2s), antidepressants (SSRIs) and diabetes (glitazones). Worse, few P&C programs seek out the legitimate reasons patients stop taking their pills — information, for example, on side effects, adverse events and special individual sensitivities and physiological traits.
For pharma CEOs, that’s a place to start looking for the real reason behind those sinking sales.