Hard to swallow?
Katy Brown and Ruth Rosselson put the pharmaceutical industry under the microscope and looks at some of the non-prescription drugs consumers might want to choose or avoid.
Raking it in
Combined drug sales for the top ten global pharmaceutical companies topped $250 billion in 2004.(1) The income of the five biggest drug companies alone is double the combined GDP of all the countrsies in sub-Saharan Africa.(2) The profit margins of the pharmaceutical industry are higher than any other industry.(3)
Drug companies claim that they must keep prices high in order to recoup research and development costs. However, the industry spends up to $60 billion a year on drug marketing - twice what it spends on research and development.(1) In 2004, Pfizer spent almost $120 million for media ads for Lipitor, the world's number-one selling prescription drug, while companies promoting erectile dysfunction treatments Viagra, Levitra and Cialis spent $425 million.(1)
Access to Essential Medicines
One-third of the world's population don't have access to the medicines they need, rising to half in some parts of Africa and Asia.(5) In the Third World the only drugs available to treat some diseases are highly toxic or ineffective. Pharmaceutical companies do not spend enough money on research and development for diseases of the poor as there is little financial incentive. Often production of certain drugs is phased out, if they don't provide big enough profit margins for the companies that make them.
Between 1975 and 1999, of the drugs approved for sale globally, only 1% targeted tropical diseases and tuberculosis, despite such diseases accounting for 11.4% of global disease. Malaria gets the most research funding of all tropical diseases but still only 0.3% of money spent on medical research and development is spent on malaria.(6) Malaria kills one child every 30 seconds (7) yet athsma receives 20 times more funding.(3) In 2000 Glaxo Wellcome (now GlaxoSmithKline) launched the first anti-malarial to be developed by a drug company in 40 years. This drug was not aimed at treatment, however, it was prevention - and marketed to the approximately seven million tourists who visit malarial regions rather than the people who live in them.(3)
The Global Fund to Fight AIDS, Tuberculosis and Malaria (www.theglobalfund.org) was created in response to the lack of availability of drugs in the Third World. Its aim is to increase resources to fight three of the world's most devastating diseases and direct those resources to areas of greatest need through partnerships between governments, civil society, the private sector and affected communities.
A special report published in July 2005 by America's Center for Public Integrity found that the pharmaceutical and health products industry in the US had spent more than $800 million in federal lobbying and campaign donations at the federal and state levels in the past seven years. In 2004, drug makers spent $123 million on lobbyists, a record amount for the industry. Of the 1,291 lobbyists listed that year as representing pharmaceutical corporations and their trade groups, some 52 percent were former federal officials. Lobbyists don't just lobby congress but an array of agencies including the Department of Health and Human Services, the Food and Drug Administration and the State Department.
In recent years, the industry has shown significant power in influencing US trade policy (and the WTO, see below). The US Trade Representative, which shapes the country's trade agreements with other nations, recently, at the behest of the pharmaceutical industry, pressured Guatemala into repealing a recently passed law permitting wider marketing of generic drugs.(1) It is this political influence that is perhaps most damaging. In America, high drug prices could be considered a devious scam but in the Third World drug pricing is a matter of life or death.
This report identifies companies trying to influence the political process by marks in the Political Activity column on the main table.
Adverse drug reactions to animal tested drugs (ADRs) are currently the fourth biggest killer in the western world after heart disease, cancer and stroke. 8 10,000 people are killed annually in the UK alone by ADRs.
Europeans for Medical Progress (www.curedisease.net) represents doctors and scientists who oppose animal testing, not because it harms animals, but because it harms humans. According to their director Kathy Archibald 'We already have superior methods of studying human diseases and developing and testing drugs to treat them: microdosing, for example, is a way of testing miniscule doses of new medicines in human volunteers in complete safety, to obtain information about human metabolism of the drug that could never be obtained by using animals. Animal tests should be compared scientifically against microdosing and other human-based methods (including human tissue and DNA chip studies) - 83% of GPs and over 140 MPs agree - please ask your MP (see www.curedisease.net). Arthritis drug Vioxx caused 320,000 heart attacks and strokes, though tests in mice and monkeys had shown it was cardioprotective. Human-based tests could have prevented this tragedy and must be used to prevent another Vioxx in future.'
Over 2.8 million animals were used in laboratory procedures in the UK in 2004, an increase of 2% on 2003 figures. Animals used included over 5,000 dogs, 100,000 birds, 200,000 fish, almost 15,000 rabbits, plus horses, cats, ferrets and millions of rodents. The major uses of animals in research are fundamental biological research (31%) and breeding of transgenic and genetically mutant animals (34%). Toxicity testing accounted for 15% of procedures. 60% were performed without anaesthetic. There were only 25 home office inspectors to police these procedures. It is estimated that over 100 million animals are used every year worldwide in laboratory experiments, at least 10-11 million of these in the EU.(9)
Animals are used in a variety of experiments all of which cause pain and suffering. Animals either die from the effects of the experiment or are killed afterwards for post mortem examination.
According to Penaran Higgs of the British Union for the Abolition of Vivisection; "It is still legal under the Animals (Scientific Procedures) Act 1986, for animals in laboratories to be subjected to poisoning, burning, blinding or electrocution, to be deprived of food, water or sleep; applied with skin and eye irritants; subjected to psychological stress; deliberately infected with disease; brain damaged; paralysed; surgically mutilated; irradiated; gassed; force fed, electrocuted and killed.'
She also pointed out that 'Many people believe that such procedures are necessary for "life-saving medical research" to take place, but the reality is that less than 25% of vivisection is for applied medical research, most of it is to profit pharmaceutical companies. We would argue that to cause such suffering in another sentient being, for whatever reason, is simply unethical."
Contrary to popular belief, animal experiments are actually very rarely required by law. There are a few cases where the law actually stipulates animal experiments, but usually the law simply requires that a company submits a certain amount of test data before a product can be marketed, without dictating the method by which that test data must be required.(15)
None of the companies covered in this report have an adequate animal testing policy and most companies conduct or commission testing (see table).
According to Jess Worth, ActionAid's HIV & AIDS Campaign and Research Officer, '40 million people worldwide have AIDS. 6.5 million of this total need antiretrovirals (ARVs) to avoid imminent death. In Africa only a tenth of these people have access to the drugs they need, as they are prohibitively expensive. As most drugs are under patent, big pharmaceutical companies have a complete monopoly over who they sell them to and how much they charge. Governments simply can't afford brand name ARV drugs at the prices charged by pharmaceutical countries to treat their people. In Africa many people live on a dollar a day or less so can't even afford discounted drugs.'
In the past three years 'generics companies', primarily in Asia have started producing and selling these drugs at just above cost price, massively undercutting the brand name drugs produced by the pharmaceutical giants. One million people are now treated due to this break with patenting law. The pharmaceutical industry has lobbied hard against this. 'These companies will do anything they can to uphold patent rights at the cost of peoples lives. Drug companies prefer to drop the prices of their own drugs and donate them at a loss or at cost price, allowing them to maintain price control. They would rather lose some money in the short term than risk losing their monopoly. AIDS victims are on treatment for life however, and without ARVs face HIV resistant strains and ultimately death so need a stable, sustainable drug source, Therefore drug donations are not a long term solution' Jess Worth, ActionAid.
In March 2001, 39 drug companies, including Bayer, Glaxo Wellcome and SmithKline Beecham (now GlaxoSmithKline), Johnson & Johnson subsidiary Janssen-Cilag, Novartis and Wyeth, (all covered in this report), took the South African government to court in an attempt to stop the country importing and manufacturing cheap generic drugs.(14)
Fortunately for the 4.2 million HIV positive people living in South Africa, the companies dropped their case in the face of enormous public pressure. Pfizer has also been criticised for blocking access to affordable, generic versions of its ARV drugs in South Africa.(16)
It's not just at government level that Big Pharma likes to exert its influence. In both the North and South, drug companies spend huge amounts employing drug reps to influence doctors' prescribing habits. In Turkey for example, drug companies have given doctors refrigerators, TVs, money, even prostitutes in return for prescribing their brands.(3) Fridges, cash and TVs have apparently been offered as bribes in India and Nepal and computers, wine and spirits are the inducements of choice in Kenya.(3) The US, Canada, Europe, Australia and New Zealand have adopted codes on drug promotion, but this doesn't mean that bribery doesn't happen, it's just less overt. In America, drug companies pay for 57% of the costs of Continuing Medical Education (CME) - seminars to keep doctors up to date on research and treatment in their fields. Other incentives include drug samples, pens and free lunches.(3) Meanwhile GlaxoSmithKline has been accused of using expensive holidays, stereos, tickets to football matches and money to persuade thousands of German and Italian doctors to prescribe its drugs.(3)
A study of young doctors in the US found just over half of those polled said they see drug reps at least once per week and nearly one quarter reported seeing reps daily.(10) Evidence shows that doctors who attend pharma-sponsored CME, receive free drug samples or accept travel expenses, are more likely to prescribe the sponsor's drug. Even small gifts can influence doctors' prescribing habits.(3)
No Free Lunch (www.nofreelunch-uk.org) is a group that campaigns against such promotion by drug companies and encourages doctors to take a pledge to go 'drug company free'.
Whilst millions of people go without the life-saving drugs they need in the Third World the pharmaceutical industry is busy looking for new profitable markets in the West. There are now drugs for a wide range of conditions that previously have been considered normal life experiences; male pattern baldness, unwanted facial hair, wrinkles and both male and female sexual dysfunction for example. Shyness has now been re-classified as Social Anxiety Disorder, for which GlaxoSmithKline has had its anti-depressant drug Seroxat (called Paxil in America) approved to treat.(3) Seroxat has been linked to self-harm and addiction and has been found to induce withdrawal effects that include nightmares and electric shock sensations in healthy volunteers.(11)
The industry also pushes for more and more people to be included in guidelines for drug treatment for existing conditions. By lobbying the World Health Organisation in 1999, when it held meetings to set high-blood-pressure guidelines, the resulting recommendations were biased towards the interests of drug companies, rather than the best medical evidence.<3> The lower the figure defining high blood pressure, the bigger the market for blood pressure lowering drugs.
According to a paper titled 'Pharmaceutical Industry Agenda Setting in Mental Health Policies' by S. Beder and R. Gosden, many companies use public relations techniques "to manipulate psychiatric thinking and public policy-making in the mental health field."(12) Companies use public relations firms to create artificial grassroots concern groups as fronts for promoting psychiatric industry products.
A number of companies including Glaxo Wellcome and SmithKlineBeecham (now GlaxoSmithKline), Hoffman-La Roche, Bayer and Bristol-Myers Squibb gave money to the National Alliance for the Mentally Ill (NAMI) which a few years ago mounted an anti-stigma campaign to advocate the elimination of discrimination against people diagnosed with schizophrenia, as long as they were on medication.(12) All of the companies, together with NAMI itself, are on the client list of Nelson Communications, a giant PR conglomerate.(12)
The pharmaceutical industry also uses its influence to set the agenda in the realm of academia. Six companies - Janssen Cilag, Eli Lilly, Pfizer, Novartis, Lundbeck and AstraZeneca, all manufacturers of schizophrenia drugs - funded the prestigious Neuroscience Institute of Schizophrenia and Allied Disorders (NISAD).(12) Beder and Gosden argued that these companies "set the agenda" by "selectively funding psychiatric research aimed at propagating the belief that mental disorders are caused by brain defects." According to the paper, the propagation of these brain-based theories had provided the "necessary framework" for arguing that drugs (rather than "talking therapy" such as psychotherapy) were suitable forms of treatment.(12)
The World Trade Organisation's (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) is an international agreement on protection of patents, copyrights, and trademarks which sets out minimum guidelines for intellectual property protection that must be met by all WTO members. TRIPS treats medicines in the same way as any other patented products ? such as compact discs or video games. It gives patents on medicines for a minimum of 20 years, so patent-holders have a monopoly over the drug for that time. During this period, when generic drugs are unavailable, governments and individuals in poor countries can't afford to buy the drugs they need.(5)
There are safeguards within TRIPS that developing countries can write into their national laws in order to protect public health. However, until recently the legislation wouldn't allow countries without the capacity to manufacture their own generic drugs to import them from countries that do. It is estimated, for example, that 350,000 people on AIDS treatment rely on India's generic production, around half of all people on ARV drugs in the Third World, Indian drug companies are widely credited with lowering the price of ARV drugs in Africa from more than $10,000 to about $300 per person each year.(5)
Under pressure from US officials, and direct lobbying from the pharmaceutical industry, many countries have failed to take full advantage of the safeguards within TRIPS when wording their own legislation. In fact India, which amended its patenting law in March 2005, not only failed to make maximum use of TRIPS flexibilities, it actually contains stronger patent protection than the WTO requires. This will severely limit the ability of the Indian generic industry to produce the next generations of ARVs, making them prohibitively expensive. This will almost certainly deprive both India's five million people living with HIV as well as patients in other developing countries of low-cost drugs.(13)
A new report by ActionAid 'Under the influence: exposing undue corporate influence over policy-making at the World Trade Organization' shows the extent to which the pharmaceutical industry was involved in pushing through the TRIPS legislation and how hard it lobbied against developing countries proposals to protect human health. Close observers report that Pfizer (makers of TCP and Sudafed on the table) in particular played a big role, negotiating directly with the WTO Secretariat and member states to find an 'acceptable' text for the 2003 agreement on TRIPS. Some accounts refer to countries holding talks on the 'Pfizer proposal'.
Peter Hardstaff, the World Development Movement's head of policy, comments; "It is a disgrace that international trade rules continue to prioritise the profits of multinational drug companies over the rights of poor countries to produce, and sell to each other, cheap generic medicines that are essential for tackling disease and ill health."
Cherry-picking publicy funded research
Contradicting drug company claims that their profits are vital to fund research and development is the fact that public money tends to support the initial hard work for drug research. Once a research angle looks financially promising, pharmaceutical companies step in. The president of top pharmaceutical company Merck's research institute pointed out: "About 95% of the fundamental discoveries that point you in the right direction come out of basic science funded by government and not-for-profit sources."(4)
As long as society gets new drugs in the end though, does it matter whether public money goes to private companies? An example from the USA suggests it does. Taxol is a drug used to treat breast and ovarian cancer. The main public funder of biomedical research in the US, the government National Institute of Health, developed the drug and paid for all the clinical trials. It gave exclusive production and manufacturing rights, however, to pharmaceutical company Bristol Myers Squibb for no royalties.(4) Bristol Myers charged $10,000 for an annual course of the drug, despite it costing just $500 to manufacture. The US government was challenged on the issue and responded with the argument that what is good for Bristol Myers is good for the US economy. Patients in the US with multiple sclerosis, breast cancer, colon cancer, heart disease and AIDS currently pay up to 100 times the actual cost for prescription drugs that have been developed with funding from the US.
- ActionAid - ActionAid UK Supporter services, Chataway House, Leach Road, Chard, Somerset, TA20 IFR
01460 238000 email@example.com www.actionaid.org.uk
- The British Union for the Abolition of Vivisection (BUAV) - BUAV, 16a Crane Grove, London N7 8NU
020 7700 4888 firstname.lastname@example.org www.buav.org
- Europeans for Medical Progress - Europeans for Medical Progress, PO Box 38604, London, W13 0YR
020 8997 1265 email@example.com www.curedisease.net
- Medecins Sans Fronti?res - Access to Essential Medicines Campaign, MSF, 67-74 Saffron Hill, London EC1N 8QX
0207 067 42 15 firstname.lastname@example.org www.accessmed-msf.org
- No Free Lunch UK - www.nofreelunch-uk.org, email@example.com.American Office No Free Lunch, P.O. Box 151, Audubon Station, New York, NY 10032 USA
- New Internationalist November 2003 Issue 362 special edition on Big Pharma. www.newint.org
1 www.publicintegrity.org viewed on 24/01/06.
2 www.marxist.com viewed on 24/01/06.
3 New Internationalist, November 2003, Issue 362.
4 Public Health or Private Wealth? by Sarah Sexton, first published 6th June 2002 www.thecornerhouse.org.uk viewed on 24/01/06.
5 www.accessmed-msf.org viewed on 24/01/06.
6 The Independent, 31/10/05.
7 www.newsmax.com viewed on 24/01/06.
8 www.fda.gov viewed on 24/01/06.
9 Summary of the 2004 statistics of scientific procedures on living animals in extracted by the BUAV from the Home Office publication: Statistics of Scientific Procedures on Living Animals, Great Britain 2004 (Published December 2005).
10 www.eyeforpharma.com viewed on 24/01/06.
11 www.bbc.co.uk viewed on 14/10/02.
12 S.Beder and R.Gosden, titled ‘Pharmaceutical Industry Agenda Setting in Mental Health Policies’, (published in Ethical Human Sciences and Services 3(3) Fall/Winter 2001).
13 ActionAid (2006) ‘Under the influence: exposing undue corporate influence over policy-making at the World Trade Organization’, London: ActionAid International
Many people these days think carefully about reaching for an over-the-counter (OTC) medicine and consider whether a natural alternative might do instead. It's perfectly possible to treat some minor ailments using plants and foods, avoiding the need for some OTC medicines altogether. For example, a simple home remedy such as honey and lemon can offer relief from flu symptoms or sore throats. Remember that all medicines need to be used with caution, natural or not, and might need to be avoided altogether if you are pregnant.
As with any medicine, it's best to be as informed as possible about what you are taking, and why. Many OTC remedies also only target specific symptoms whereas many of the complementary therapies aim to treat the whole person rather than just the symptoms.
- White willow bark Aspirin was initially derived from white willow and both contain the active ingredient salicylic acid. Like aspirin, it is useful for headaches, pains and fever.
- Feverfew Research has shown that this herb may be useful for migraines and headaches although it is mainly effective as a preventative agent and may need to be taken for several weeks before relief is felt.(1) It contains parthenolide which relaxes constricted blood vessels in the brain. Not to be used by pregnant women.
- Cognitive Behaviour Therapy (CBT) A 1999 review of research reported that a range of studies found that CBT was effective in reducing the pain experience and improving coping in individuals who were suffering with chronic pain.(2)
- Recent research into Acupuncture shows that it deactivates the area of the brain which governs pain and should be taken more seriously for pain relief.(3)
Weleda, Viridian, and Neal's Yard have all previously been best buys in Ethical Consumer magazine.
1 www.migraine.org.uk viewed 25/01/06 www.internethealthlibrary.com/Health-problems/Migraine-research-AltTherapies.htm www.organicfood.co.uk/herbs/feverfew.html
2 Journal, Pain, 1999 80. 1- 13.
3 http://news.bbc.co.uk/2/hi/health/4631930.stm 21/1/06 bbc website 30/4/05