By Anne Casey
Chances are your GP sees on average two drug company representatives a week, meeting each on average three times a year and spending 11 minutes with each. He or she will spend about 80 minutes each week reading medical newspapers and journals largely funded by drug company advertisements, spend 14 minutes reading drug company mailings and attend seven meetings a year, mostly organised by drug companies.
These are some of the results of a survey conducted in 1990 by Quadrant Research services. They indicate the substantial influence the pharmaceutical drug industry has over doctors.
The pharmaceutical drug trade is one of the fastest growing components of Australia's health bill. Australians spend $2 billion a year for prescription drugs. In addition, it's estimated that in 1991 $1.4 billion was spent on over the counter drugs.
When the Pharmaceutical Benefits Scheme was set up 30 years ago to provide Australians with prescription medications, there were 139 "life-saving" drugs on the list. Today PBS lists 1160 items, representing 545 drug substances for which 94 million scripts are written annually by doctors.
The majority of popular prescription drugs are less than 15 years old, yet most doctors graduated more than 15 years ago. Where do GPs learn about the medicines they prescribe?
Representatives from the drug companies play a big role — only 7% of doctors don't see them. But the main source of doctors' knowledge is the medical press, which consists of half a dozen profitable publications plus a few unprofitable ones — many more publications than is usual for one industry. They are overwhelmingly funded by drug company advertisements.
Most of these publications are sent free to all GPs. Four specialist groups are also included on the free list: cardiologists, respiratory specialists, rheumatologists and gastroenterologists. Industry sources say the drugs prescribed by these four specialist groups account for more than 80% of drug company advertising.
The importance placed on advertising by the drug companies is apparent from the careful readership profiles they assemble. All research breaks doctors down by age, sex, number of people in the practice, year of graduation and number of scripts written a day.
Advertisers of course favour publications that reach doctors who write scripts readily. They are also the ones who get invited to the dinners and symposia.
An important promotional tool is the supplement. Sometimes drug companies would like to make claims about their product but cannot find references to support them from the literature. In this case they may sponsor a supplement, which will carry research of such a minor nature it would not normally make it into the main part of a reputable journal. Editors, while saying everything that appears in the supplement is true, admit a lower standard of scientific importance applies.
At stake is an enormous business employing 8500 people, which is part of an industry worth more than $150 billion worldwide.
Hence capturing the market is a key concern. The overwhelming interest marketing holds for the prescription drug industry is revealed in a 1987 survey by the Australian Pharmaceutical Manufacturers Association (APMA). It found that 2.2% of the industry works in the medical department, 2.2% in research and development, 4.9% in quality assurance and a huge 25.5% in marketing. A repeat of the survey in 1990 found almost 30% work in marketing.
Companies rely heavily on a few products to make their money. The APMA found that among the top 10 companies, the most successful product accounts for 40% of sales. The two best account for 60% and the three best 70% of sales.
John Leso is a member of the Campaign Against Fraudulent Medical Research, a non-profit organisation which documents the experiments and safety trials performed by drug companies. Speaking to 91×ÔÅÄÂÛ̳ Weekly, he says, "Fraudulent research is rife among drug companies. The incentives to come up with a marketable drug are enormous.
"Pharmaceutical companies estimate that it costs them $290 million to develop a new drug. But if they find a drug that can both create and satisfy a mass market need, then they hit the jackpot."
For example, one such drug is Cimetidine, effective in treating ulcers. In 1976, Smith, Kline and French called it Tagamet, and it became the first prescription drug to make $1 billion in sales.
Because of the astronomical profits involved, companies are very reluctant to see their product withdrawn from the market. Says Leso, "When a drug causes problems, the company will do
further research to 'prove' their drug is safe and should remain on the market. Those that do finally get withdrawn often end up in Third World countries without the information on side effects."
Drug companies also maintain tight monopolies on their products. Ken Davis of the AIDS Council of NSW told 91×ÔÅÄÂÛ̳, "Only one company manufactures AZT other than Burroughs Wellcome. That's the Indian company Cipla. They're able to manufacture it fairly cheaply, but no country can afford to break the patent. For example, other Asian countries can't decide easily to buy Indian AZT rather than Burroughs Wellcome AZT because the cost of going against the international drug companies is enormous.
"The bulk of the price charged for AZT is profit for Burroughs Wellcome. HIV drugs make up an enormous percentage of the overall profits for that company."
Doctors are the point of intersection between the drug companies' products and the patient. In Japan, drug companies have developed a unique relationship with doctors. Japan spends more on drugs than any country in the world: $228 per person each year, compared with $169 in western Germany, the second most prolific pill popper.
Japanese doctors not only prescribe drugs; they also dispense them. The doctors buy their drugs from wholesalers who typically sell them at a discount on the official prices set by the government. Doctors are reimbursed by the government for the drugs they prescribe — but at the official price.
This system encourages doctors to use lots of expensive drugs and pocket the difference between the discount price and the official price. As a result, the average Japanese general practitioner earns $327,000 a year, most of which is made by selling drugs, compared with the average $213,000 a year earned by the average US doctor.
The drug firms employ hordes of salespeople, visiting the GP on average 12.8 times a year, to negotiate each doctor's cut of the profits.
Since the beginning of the '60s, drug industry profits (as a percentage of sales and companies' net worth) have surpassed all other manufacturing industries listed on the US Stock Exchange.
A February report by the US Office of Technology Assessment concluded that drug companies have been making profits in excess of $2 billion a year. Between 1976 and 1987 the drug companies earned returns on investment that (after allowing for risk) were
two to three percentage points higher than other companies. US drug firms dominate international markets. The result is a trade surplus of more than $1 billion a year in medical and pharmaceutical products.
At the helm of this national and international domination is the Rockefeller family fortune. In 1949 US investigative reporter Morris A. Bealle documented the beginnings of this huge industrial combine.
According to Bealle, the Rockefeller empire (which was built on Standard Oil Company) in the early part of this century became interested in the drug trade after making breath-taking profits from palming off bottled petroleum, called Nujol, as a supposed cure for cancer and later for constipation.
In 1939 the Drug Trust was formed by an alliance of the two greatest cartels in world history — the Rockefeller empire and the German chemical company, I.G. Farbenindustrie (I.G. Farben). Drug profits from that time onwards curved up into gigantic proportions and by 1948 it became a $10 billion a year industry.
I.G. Farben's past is highlighted by the fact that during the Second World War it built and operated a massive chemical plant at Auschwitz using slave labour. Approximately 300,000 concentration camp workers passed through I. G. Farben's facilities at Auschwitz and at least 25,000 of them were worked to death. Twelve of I. G. Farben's top executives were sentenced to terms of imprisonment for slavery and mistreatment offences at the Nuremburg war crime trials.
Hoechst and Bayer, the largest and third largest companies in world pharmaceutical sales respectively, are descended from I.G. Farben.
The Rockefellers gave billions of dollars worth of gifts to colleges and public agencies within the United States who taught Rockefeller drug lore. In 1927 they formed the International Education Board, which similarly "donated" millions of dollars to foreign universities and politicos.
As these huge amounts of money were being "donated" to drug- propagandising colleges, the Rockefeller interests were expanding worldwide. Already 40 years ago Bealle wrote:
"It has long been demonstrated that the Rockefeller interests have created, built up and developed the most far reaching industrial empire ever conceived in the mind of man (sic). Standard Oil is of course the foundation industry upon which all the other industries have been built ...
"The keystone of this mammoth industrial empire is the Chase National Bank with 27 branches in New York City and 21 in foreign countries [now renamed the Chase Manhattan Bank with over 200 branches in the US and abroad]. Not the least of its holdings are in the drug business. The Rockefellers own the largest drug manufacturing combine in the world and use all their other interests to bring pressure to increase the sale of drugs."
In 1979 President Carter was moved to proclaim, "The oil lobby, perhaps the most powerful lobby on earth, is almost matched by hospital owners and doctors".
In 1980 Exxon became America's largest corporation. Exxon is the new name for the old Rockefeller Standard Oil Trust.
What effect has this domination of the industry by the companies had on our health?
According to the US Food and Drug Administration, 1.5 million people in the US were hospitalised in 1978 as a consequence of taking drugs, and some 30% of all hospitalised people are further damaged by their treatments. Every year an estimated 140,000 North Americans are killed because of drug taking; one in seven hospital beds is taken up by patients suffering from adverse drug reactions.
In Australia, Dr Julian Gold, head of the National Health Surveillance Unit of the Commonwealth Institute of Health, estimates that up to 40% of all patients in Australia may actually be victims of doctor-induced (iatrogenic) illnesses. Of this amount, generally half are from drug reactions.
Today drugs are highly toxic substances because they are generally composed of artificial chemical compounds synthesised in the laboratory. In the past, before drugs became big business, nearly all medicines were composed of natural, plant-derived ingredients that were far safer.
Drug companies choose to synthesise the ingredients because they are cheaper to produce and can be patented, giving the companies monopoly rights on their sales.
Every doctor knows the dangers of the drugs they administer. Each has a copy of the MIMS Annual, containing information on the effects of the drugs. Even then this is unlikely to reveal the full extent of possible side effects because it is the information which the drug companies themselves provide.
However, it is revealing enough. Fluorouracil, one of the main drugs used in the treatment of bowel cancer, is described as "a highly toxic drug with a narrow margin of safety ...
Severe haematological toxicity, gastrointestinal haemorrhage and even death may result from the use of fluorouracil despite meticulous selection of patients and careful adjustment of dosage."
This is the best option offered after literally billions of dollars have been channelled into cancer research.
Alternatives to the drug company monopolies are ruthlessly suppressed by bodies such as the American Medical Association, the US Food and Drug Administration and the Australian Medical Association.
Jenny Burke of Australian Biologics told 91×ÔÅÄÂÛ̳, "Until conventional medicine gets perfect results, they can't afford to ignore anything, and they're certainly not getting perfect results.
"People must have the right to access a wide range of possible health options and to determine their efficacy for themselves. Instead they are faced with doctors who will readily hand over scripts but who do not even know of important developments in health which are taking place outside the narrow sphere of the drug companies.
"We're told that natural and alternative therapies are hurting people, but the real damage is being inflicted by the monopoly drug companies and the doctors who refuse to inform themselves. This is the real crime."
A US publication, the Civil Abolitionist last year reported that on May 6, 1992, the clinic of Jonathan Wright MD, a highly regarded nutrition specialist, was assailed by 22 armed men because the doctor had been treating his patients with natural substances that didn't meet the FDA's approval.
During the SWAT-type attack, the front door was kicked open, guns were pointed directly at staff, and the shocked patients were herded into a room. Patient records, equipment, business records and vitamin supplies were confiscated. At the time of the article, the FDA had not filed charges against Dr Wright.
Last year similar actions took place against three manufacturers of vitamin supplements (Allergy Research, Thorne Research and Highland Laboratories).
A bill pending in the US House of Representatives would make vitamins, minerals and herbs unavailable except through prescription from medical doctors, prevent food supplements from entering the country and make it illegal for anyone to sell vitamins, minerals and herbs with a fine of up to US$1 million
for each violation plus a $250,000 fine against the store. A bill identical in nature has been passed in the UK and a similar one is on the table in several European countries and Canada.
In Australia, a repeal of Schedule 1, Exemptions of the Therapeutic Goods Act, scheduled for January 1994, would minimise access to natural therapy and threaten the existence of the natural therapy profession and manufacturers of natural remedies.
The domination of health care by powerful monopolies extracting billions of dollars in profit means that people's health is deteriorating while government health care bills soar.
The Australian system is heading down the path of the United States. If politicians decide that Medicare is too costly a budget item, then individual Australians will have to foot the bill or go without the necessary health care.
Inequality in health care is an issue that confronts Ken Davis in his work with the AIDS Council. "It's possible that Australia will be seen to have responded relatively well to the AIDS crisis, but it is likely to be surrounded by countries where the epidemic is explosive and where masses of people have minimal access to prevention, health and support services.
"Even within Western cities such as New York, some people are able to access preventive drugs and treatments early in their HIV illness, and other people only access any health care a day or two before they die. This is dictated by class, race and gender.
"The global struggle for health requires not simply the defence of access to health programs and drugs but also a struggle against poverty and sexism and for basic human rights."