NARRATION: Through drug advertisements costing billions….Madison Ave has turned patients into a potent sales force…influencing which drugs their doctors prescribe.
NARRATION: For the big pharmaceutical companies, these campaigns have been an unquestioned success, boosting sales…making brand name drugs as recognizable as the latest movie star. It's what advertising agencies do well: to unabashedly promote and sell products.
NARRATION: But now, Madison Ave, is quietly engaged in a much different campaign. To help create the next generation of blockbuster drugs, ad agencies are buying or investing in companies engaged in the actual science of drug development….including organizing clinical trials. Some ad agencies also own companies that ghostwrite scientific journals…and design medical education courses.
BODENHEIMER: The hidden hand of Madison Avenue is having an enormous effect on the prescribing habits of physicians in this country.
NARRATION: And that deeply worries some doctors.
RELMAN: Ad agencies are not in the business of doing science. They're not qualified to do science. They're not qualified to carry out clinical investigation, and they don't belong there.
NARRATION: For 14 years, Dr. Arnold Relman edited the New England Journal of Medicine.
RELMAN: These people make their living by promoting the sales of drugs.
TORRE: Some scientific people are worried that marketing might influence the science of a drug. That really can't happen.
NARRATION: Joe Torre…not to be confused with the baseball manager…is the award-winning, Ferrari-driving chief executive of the ad agency, Torre Lazur. It's known as the launch agency.
TORRE: We've launched over 65 new pharmaceutical products.
NARRATION: And to help launch even more products, Torre Lazur early this year bought its own clinical research firm, Target Research Associates…so the agency no longer merely markets new drugs, it now studies the benefits and dangers of experimental drugs.
TORRE: We provide services that go from the beginning of drug development all the way to the launch of your products.
WALT: From soup to nuts.
TORRE: From soup to nuts.
WALT: Is that new for advertising agencies?
TORRE: I'd say within the last decade it's new. Prior to that, advertising agencies used to be just that - advertising agencies.
NARRATION: According to Dr. Thomas Bodenheimer, clinical drug trials used to be performed mostly by academic medical centers. But in the New England Journal of Medicine, he writes that these trials are increasingly being done by private research companies like Target.
BODENHEIMER: Their only income comes from drug companies that contract with them to do these clinical drug trials, so they really have no independence from the drug companies.
BODENHEIMER: Their purpose is not scientific truth. So they can decide which data to publicize, and which data to bury.
NARRATION: Such worries are baseless, says Lloyd Baroody, who heads Target Research.
BAROODY: It's totally against the rules and it could be criminal. I can't imagine any colleague of mine in my company or in the industry that would put marketing before research in terms of trying to say something about a drug that only emphasizes the most favorable elements but buries the unfavorable elements. You know, it's just, it's just generally - I can't imagine it happening. I really can't.
RELMAN: He kept a straight face when he said that?
WALT: You don't believe it?
RELMAN: On the face of it, that's ridiculous.
NARRATION: A view shared by Dr. Eric Topol, who chairs the department of cardiovascular medicine at The Cleveland Clinic.
WALT: Is there a place for advertising agencies or their representatives in designing clinical trials and promoting the results of those trials?
TOPOL: Well, actually this is pretty scary to me. This is what I would label "bad chemistry." If this is where clinical research is headed, that would be a terrible negative trajectory.
NARRATION: A case in point, says Dr. Topol: the new pain reliever Bextra. The Food and Drug Administration approved Bextra for mild pain like arthritis, but not for acute pain. Even so, six months later a private research company - Scirex - partly owned by the ad agency Omnicom, released a new study showing that Bextra did relieve acute pain from dental surgery. Bextra can't be advertised for acute pain, but doctors are free to prescribe it for that purpose.
TOPOL: It looked like the deck was stacked for Bextra - no surprise of course.
NARRATION: Dr. Topol said the study's conclusions were based on a sample size …that may have been too small and too healthy. He has also criticized other studies of pain relievers in the same class of drugs as Bextra.
TOPOL: The question is, why can't they do the trials right? They have so much revenue and income. To do a trial done in the right way with independent investigators, with the right type of statistics and sample size and population is relatively little cost.
NARRATION: The ad agency Omnicom, which announced that it was investing in Scirex to - quote -- get closer to the test tube -- tells The New York Times in response to our questions that it has no influence over Scirex's management or the design of clinical studies. Scirex would not return our calls.
NEWS BROADCASTS: [Various news broadcasts trumpeting new studies.]
NARRATION: New medical studies, trumpeted frequently on the evening news, are important because they help doctors decide which drugs to prescribe…directly affecting the cost and quality of patient care.
NARRATION: Linda Logdberg knows the importance of these studies. She has written about them for medical journals.
WALT: If I were to look up the research papers that you wrote, would I find your name on them?
LOGDBERG: No, you would not find my name on them.
WALT: You're a ghostwriter.
LOGDBERG: I'm a ghostwriter.
NARRATION: In other words, doctors take credit for authoring studies that Linda Logdberg wrote. Though leading medical journals disapprove of ghostwriting, Dr. Logdberg -she has a doctorate in anatomy -- didn't object as long as the research was presented fairly and objectively. But she says that when business executives at advertising agencies began telling her what to write, she grew increasingly uncomfortable.
WALT: You are a bit like the puppeteer. You pull the strings and the doctors dance.
LOGDBERG: I pull the strings after being told how to pull the strings.
WALT: Who is telling you pull the strings?
LOGDBERG: My contact at the medical education company.
WALT: Which is owned by -
LOGDBERG: An advertising agency.
NARRATION: Dr. Logdberg says that several months ago she got a call from Intramed, a company that educates doctors about new developments in medicine. It's owned by the marketing company, Sudler & Hennessey, which in turn is owned by the global ad agency, WPP.
LOGDBERG: They asked me to rewrite an article that they were not happy with.
WALT: Why weren't they happy with it?
LOGDBERG: They felt it was rambling and that it didn't make the points that they wanted to see made.
NARRATION: The research paper - on Attention Deficity Hyperactivity Disorder -- was also deemed unsatisfactory by Novartis, the maker of Ritalin L.A., a drug used to treat the disorder. New York Times reporter Melody Petersen obtained a transcript of a telephone conversation that shows just how hard Intramed and Novartis worked behind the scenes to get the paper written - the way they wanted it written - even though the relevant clinical trial for Ritalin L.A. had yet to begin.
PETERSEN: The company wanted what he called a quote, quick, down and dirty article that could be published very quickly.
NARRATION: And while Novartis told the authors to stick to known facts, they should feel free to hint at what future research might show, according to the transcript. And to make sure the article turned out the way the drug company wanted --
PETERSEN: An Intramed executive told the doctors that it would give them an outline and a draft of the paper which then they could edit.
NARRATION: Novartis said it was not the article's intent to promote any specific drug. Intramed declined to appear on camera to discuss this research paper, which is awaiting publication. But Jed Beitler, chief executive of Intramed's parent company, Sudler & Hennessey, did speak to Melody Petersen.
PETERSEN: Mr. Beitler said Intramed may make editorial suggestions to authors but that it does not ghost write. He said that in this case, the doctors had originally written a piece that was far too long. So, Intramed had written a draft to show them how it could be scaled down.
NARRATION: Even so, Dr. Logdberg was called in for a rewrite, which Intramed also didn't like. For now, Dr. Logdberg says she has quit ghostwriting because marketing executives - not scientists or researchers - were shaping what she wrote. Today she teaches science to students… working longer hours for less money.
LOGDBERG: What I mind is advertising that calls itself education. And I became increasingly uncomfortable with providing content for that.
NARRATION: Someone who says he has been on the receiving end of Intramed's medical education is retired psychiatrist, Dr. Richard Brown. He says that education was accompanied by a $500 check, wine and a free dinner at Daniel, one of the most elegant, and expensive restaurants in New York City.
NARRATION: Dr. Brown invited us to come along to document the free dinners he was getting from the drug industry. He says he wants to end the practice.
BROWN: I am disgusted by the fact that these pharmaceutical companies can charge so much for drugs, such that poor people have to stretch their budgets to pay for food and heating fuel, and so forth, as well as the, the high costs of drugs, and the drug companies, at the same time, can give these lavish dinners. And I think it's disgusting, and I think this ought to be brought to the attention of the American people.
NARRATION: Drug companies that offer such lavish treatment to induce doctors to prescribe certain drugs, have been warned by federal health officials that they could be prosecuted under anti-kickback laws. But Intramed - in this case working for the drug company Forest Laboratories - insists it did nothing wrong because doctors attending the dinners were there as consultants.
RELMAN: It's nonsense. If you look into it, the doctors who are being paid ostensibly as consultants are, are doing nothing of any consequence to earn their money.
WALT: Do you do any consulting?
BROWN: Of course not.
RELMAN: They're clearly there because they are quote, either big prescribers or opinion leaders and they can influence the sales of drugs. So the whole thing is a scam - it's simply a way to sell more drugs.
NARRATION: Several weeks after the Daniel dinner, we caught up with Dr. Brown after another dinner - this time at a Manhattan steak house. It, too, was underwritten by Forest Laboratories.
BROWN: The dinner is so gigantic that I could only eat part of it. So, I put the rest in my doggie bag.
NARRATION: Days later, we watched as Dr. Brown was about to collect his third free dinner.
WALT: Good night.
BROWN: Good night.
NARRATION: Tonight, Dr. Brown would again pick up a $500 check… this time it was the pharmaceutical company, Eli Lilly, using another marketing firm to arrange the event. Dr. Brown says he had earlier turned down his fourth free dinner at the Four Seasons Hotel. Instead, he organized a protest outside as Forest Labs wined and dined doctors inside.
NARRATION: Forest Labs would not return our phone calls. But Eli Lilly and Intramed told Melody Petersen that their meetings were proper, and were designed to get feedback from doctors on specific drugs.
NARRATION: Joe Torre, the ad agency executive, says dinner meetings, often chaired by other doctors, help drug companies sell their products.
TORRE: Very often doctors are more influenced by what other doctors say than what pharmaceutical companies say. So companies work through medical education companies to have doctors who support their products talk about their products in a favorable way. That's called medical education.
WALT: How do you know that works?
TORRE: They have studies that show before and after in terms of prescribing practices.
NARRATION: Intramed reaches out to potential prescribers even before they can legally prescribe drugs. Last month, Intramed arranged for medical students from dozens of schools to spend a weekend in Manhattan, including two nights at the Plaza Hotel, dinners and a Broadway play. The purpose of the visit: a university conference on psychiatry and neuroscience, underwritten by Forest Labs, which makes antidepressants.
NARRATION: Lenard Lesser, a medical student at the University of Rochester, sent a letter to conference organizers protesting Forest Lab's involvement.
WALT: Your fellow medical students from around the country right now are settling into what promises to be a very nice dinner at the world-famous Plaza Hotel. Why aren't you with them?
LESSER: Because I believe that Forest pharmaceutical company is sponsoring this conference for an economic gain for themselves. They're trying to establish a relationship with medical students.
NARRATION: Intramed did not want us to videotape the medical students getting their free drinks and dinner inside the Plaza.
RELMAN: If what you're doing cannot be fully disclosed to the public, its wrong.
NARRATION: But the larger question remains: why ad agencies feel the need to get involved in early drug development. Mr. Baroody, the head of Target Research, says marketing executives can help target medical conditions that might be fertile ground for the development of new blockbuster drugs.
BAROODY: Drug development should to a large extent be marketing driven because, after all, drug companies are for profit institutions out to make a profit.
NARRATION: In the creative minds of some advertising executives, this is how promotion comes together with science. Produced by a company partly owned by Omnicom, this ad suggests: "Even good science needs a little magic."
WALT: Well, does science need a little magic every now and then?
WALT: What does it need?
RELMAN: It needs hard work, imagination, honesty, integrity, um, logic. It needs data. We don't get anywhere in medicine without objective data. That's the coin of the realm. These companies are not really qualified to do that, and they're not motivated to do that. Their job is to please their clients.
NARRATION: Last year, with health care costs rising sharply once again, spending on prescription drugs rose nearly 14 percent. And Fortune magazine ranks the pharmaceutical industry as the most profitable in America.
RELMAN: Doctors are led to prescribe drugs that may not be necessarily worth the money, may not be better than a generic that's already on the market and that their, that their patients don't really need. It's clearly contributing to the rising costs of prescription drugs and health care in general. And I don't think the public should stand for it much longer. The public ought to say to the medical profession - stop it. And the medical professional could easily stop it if they want to.