May 16, 2008

BILL MOYERS: One of the other issues we're going to be hearing a lot about in the next few months is the high cost of prescription drugs. Most of us can testify to the fact that drugs save lives. When I had heart surgery fourteen years ago, my own life was saved by a skilled surgical team, a caring wife, and some remarkable drugs. But drugs are costly -and it seems their price keeps rising. The sticker shock has sent many people -especially the elderly - across the border to Mexico and Canada in pursuit of affordable medicine. And a report this week says that because of the cost, many middle class baby boomers are trying to do without. The pharmaceutical companies say you get what you pay for, they say it's not cheap to develop new medicines. But in journalism as in medicine, it's always helpful to get a second opinion. So if the cost of your daily meds leaves you feeling sad and depressed, unable to sleep or eat, I have a prescription for you - a consultation with the journalist Melody Petersen, who has written a powerful new book about what ails us.

Once upon a time — she says — around 25 years ago, in fact — prescription drug ads were rare on television. Now you can't escape them.

AD #1: ...with one little pill taken just once a day...

AD#2: I feel anxious. Can't make any decisions...

AD#3: ...fortunately, there's Mirapex

AD#4: Paxil CR

AD#5: Zetia

AD#6: VIOXX is there to help

AD# 7: Viva VIAGRA

BILL MOYERS: In a single generation, ads like those have helped to make America the world's greatest medicine show. That's journalist Melody Petersen's term for it in her book, OUR DAILY MEDS.

As a reporter for THE NEW YORK TIMES Melody Petersen covered the drug industry for four years, winning one of the highest honors in business journalism - the Gerald Loeb Award. Then she spent another four years researching and writing this book. She concludes that selling prescription drugs - rather than discovering them - has become the industry's obsession.

She found companies pitching drugs with cartoon characters, popping up on email and websites, on buses and street corners, at NASCAR races and even at the world-famous state fair in Iowa where Melody Petersen grew up....

MELODY PETERSEN: It was like Disneyland - this little critter, which was the mascot for Lamisil, a pill for toenail fungus. He was out there doing a jig with the children - and I found these marketing tactics just about everywhere.

BILL MOYERS: Here you are possessed to stay with one subject for eight years. Most journalists I know who spend so much time, do so much research, so obsessed with one subject will tell me that they had an epiphany, they had a moment when they said, 'This is what I'm going to do -the big investment of my life." Was there a moment for you?

MELODY PETERSEN: It was actually gradual. When I started writing about the pharmaceutical companies for The Times I didn't know anything about the drug companies and I actually thought that they were a lot about science. That's what they tell the public. They are all about science and discovering new drugs. But as I started to follow their daily activities and talk to executives, I learned that really it was marketing that drove them.

BILL MOYERS: Was there something you saw that precipitated this choice?

MELODY PETERSEN: There's a study that the FDA often cites-

BILL MOYERS: Federal Drug Administration?

MELODY PETERSEN: Uh-huh. That a 100,000 Americans die every year from their prescription drugs - that they took just as the doctor directed. This isn't when a doctor or a pharmacist made a mistake or the patient accidentally took too much. This is when everything supposedly went right. So, that just shows you how dangerous these products are.

BILL MOYERS: Petersen reports that Americans spend more on medicines than do all the people of Japan, Germany, France, Italy, Spain, Great Britain, Australia, New Zealand, Canada, Mexico, Brazil and Argentina combined. The relentless marketing has enriched corporate executives and sent stock prices soaring.

BILL MOYERS: What's the most conspicuous example of the aggressive marketing?

MELODY PETERSEN: The obvious example is the television ads. Only those ads are only allowed in the United States and New Zealand. So those are pretty much an American creation.

BILL MOYERS: You mean drug companies can't advertise in other countries on television?

MELODY PETERSEN: No. They can't advertise anywhere directly to consumers. They can advertise to doctors in other countries but not to us.

BILL MOYERS: You write, "This book is about how America's for-profit medical system, filled with incentives to make money and disincentives for good care has failed. In too many cases, whether a medicine helps or harms a patient has become secondary to how much it will bring shareholders in profit. Why should the drug industry be an exception to what all corporations, all business does?

MELODY PETERSEN: With medicines we're talking about life and death. With Wall Street driving it, there's this constant pressure to exceed the level of revenues that you made the year before. The result of this push from Wall Street-executive stock options depend on it. If the drug companies don't do this, their stock price goes down. Executive salaries go down. It's just driven to get those profits up. I write about one study in Iowa. A group of researchers looked at Alzheimer's patients who had just been diagnosed to see what medicines they had been taking before this diagnosis, they found that 30 percent of these patients were taking medicines that could cause dementia. Rather than stopping those medicines, the doctors just added a prescription for Alzheimer's. And we just learned with the antidepressants like Zoloft and Paxil they found that in about half the studies dozens of studies that were done of these antidepressants, the sugar pill- the placebo worked just as well or better than the drug.

BILL MOYERS: What do you conclude from that?

MELODY PETERSEN: There's a lot of money to be made.

BILL MOYERS: From selling a drug that works no better than a placebo?

MELODY PETERSEN: Uh-huh. If it doesn't work, if the patient still has the problem, what happens in American medicine today? The doctor prescribes yet another pill. So there is a lot of money in selling drugs that don't work.

BILL MOYERS: Petersen reports that almost 65 percent of the nation now takes a drug available only by prescription. Aggressive marketing has turned what were once normal life events into maladies that can be treated with a pill. With our consumer-driven culture, she says, America was ripe to become "a perfect medicine market," where the power of marketing can take an obscure niche drug and turn it into a best seller.

DETROL AD: The worry that your problem is as obvious as if you'd announced it to the world. But the good news is that overactive bladder is a real medical condition the symptoms can be treated. And the great news...

BILL MOYERS: "It's a real medical condition" the announcer tells us, guessing few had heard of it.

DETROL AD: Gotta go, gotta go, gotta go...With just one pill...

BILL MOYERS: The existing condition was called incontinence, and only a small percentage of people suffered from it. But the makers of Detrol weren't satisfied with so tiny a market. They needed a best seller. So they funded seminars and wined and dined urologists to persuade them that, in fact, there could be a new medical's all part of a grand marketing strategy of which ads are only the most visible tip

MELODY PETERSEN: A very powerful technique that the drug companies spend millions and millions of dollars on is hiring physicians to give lectures to other physicians on their drugs. So, it looks like this physician is up there giving his independent opinion on this drug. But, he often, he's been trained by an advertising agency. His slide presentation has been created by an ad agency. It looks like independent science, but it's not.

BILL MOYERS: Writing a story about the pain killers VIOXX and CELEBREX, she made an interesting discovery.

MELODY PETERSEN: I wanted a rheumatologist to just give me his opinion about these drugs. So I called a leading society of rheumatologists in the country and told them I want an expert. But I don't want anyone who's being paid by either one of these companies. And they said, "Well, we have lots and lots of experts. But they're all being paid by one of these companies."

BILL MOYERS: The marketing techniques, she found, extend far beyond simply rewarding agreeable doctors and go to the science, itself.

MELODY PETERSEN: They have a technique, which they benignly call publications planning. And what this is they want to get as many articles published in our medical journals as they can that show their products in favorable lights, and will get physicians to prescribe them. So, they often hire a Madison Avenue ad agency to write up an article for them or a study and the name of the ad agency rarely appears in the published version. Instead, they hire doctors to put their names on as author.

BILL MOYERS: Boosted by medical experts, the makers of Detrol were able to convince millions they might have a new ailment...

DETROL AD: ...You've got better ways to spend your day then worrying about wetting accidents or rushing to the bathroom.

BILL MOYERS: Presto! A blockbuster drug exploded in the market. Companies had figured out how to create a billion dollar matter that later research revealed that Detrol also made it difficult for older people to walk or take a shower or even feed themselves. Encouraged by record-breaking, share-boosting profits, she writes, the companies have poured even more resources into their marketing efforts pushing the boundaries for what might be considered a disease.

PAXIL AD: I'm always thinking something terrible is going to happen, I can't handle it.

BILL MOYERS: People who worried too much were encouraged to believe they might be suffering from a condition known as "generalized anxiety disorder." Paxil, once prescribed as an anti-depressant could ease it.

PMDD AD: A week before my periods, I get super moody ...

BILL MOYERS: Even women suffering from PMS were told they could have premenstrual Dysphoric Disorder or PMDD.

PMDD AD: Sarafem...a distinct medical condition...

BILL MOYERS: Prozac, once an anti-depressant, was re-packaged and re-purposed as Sarafem.

PMDD AD: Only prescription medication for PMDD...

BILL MOYERS: What are the dangers as you see them from all this medication?

MELODY PETERSEN: First of all, that people are taking drugs they don't need. Because every drug is a balance between its potential benefits and its potential risks. If you take a drug you don't need, then you can only suffer the risks.

BILL MOYERS: Ads, by law, mention some of those risks-but on television they come in a fast-talking, easy-to-avoid package.

COMMERCIAL VOICEOVER: Side affects may include decreased appetite, dry mouth, sweating, nausea, constipation.

MIRAPEX AD: Or if you experience increased gambling, sexual or other intense urges...

COMMERCIAL VOICEOVER: Some risk of dependency. Side effects may include unpleasant taste, headache, drowsiness...

BILL MOYERS: Don't you think a lot of people are willing to take risks to have a better life? More joy? More life experiences as the ad says? More sleep?

MELODY PETERSEN: Uh-huh. We want to believe in this. We want to believe that we can just take a pill and life will be better, our problems will disappear.

BILL MOYERS: You say, "The medicine merchants have learned to sell us hopes and dreams. A pill for every desire. Too few of us realize the dangers. "

MELODY PETERSEN: All you have to do is watch television and you will see this. It'll show patients hiking through the woods. They're dancing on a dinner cruise. They're running on the beach. They look like they are having such a good time. So yes, they're selling you what you wish you could be or wish you could do.

COMMERCIAL VOICEOVER: Maybe you've tried medicine but you're still waiting to enjoy life again...

BILL MOYERS: In many cases, Petersen writes, it is the marketers and not the scientists who decide which drugs are right for the new you.

COMMERCIAL VOICEOVER: You're unable to feel. You get overly startled and may have trouble sleeping.

BILL MOYERS: To boost sales of the anti-depressant Zoloft, Pfizer sought to expand the potential market by commissioning studies that suggested that the disorder PTSD was not as rare as most believed.

ZOLOFT AD: These are some symptoms of Post Traumatic Stress Disorder. A serious medical condition affecting over thirteen million Americans. While the cause is unknown ...

MELODY PETERSEN: A few years back, I kept getting information from a group called the PTSD Alliance. PTSD is Post Traumatic Stress Disorder. And one of the main messages of this group was that five percent of the American public suffered from PTSD. And this is estimate was millions and millions more than the government actually said suffered from this illness.

And later, I learned that this group wasn't actually what I thought it was. It was the creation of a public relations firm working for Pfizer to sell more Zoloft. In fact, it was staffed by the public relations firm. Its offices were the same address of the public relations firm.

BILL MOYERS: She found example after example of science compromised by marketing.

MELODY PETERSEN: You know, it's gone so far that some independent scientists are starting to view our medical literature as propaganda. I've learned that there are so many different ways for a study to be designed to get the data that will help you sell your drug. If you want to make it look more powerful than an older drug on the market, you give the volunteers in your trial the older drug at a dose that is too low to really help them so your drug looks better. If you want your drug to look safer than an older drug you boost the dose up of the older drug in the volunteers so they have more side effects. If you have one study that showed it worked, and one study showed it didn't, you publish the first study over and over again with the help of your advertising agency. And you don't publish the second one.

BILL MOYERS: Are we being deliberately misled?


BILL MOYERS: Intentionally?

MELODY PETERSEN: Yes, looking at documents from inside the drug companies, yes. I would say we're being misled deliberately.

BILL MOYERS: I was fascinated to read an attack on your book. A seething review in THE NEW YORK POST right here in New York. "Hard Pill to Swallow." It's very critical of your book. By Robert Goldberg. It says nothing about who Robert Goldberg is. But when you do a little investigation he turns out to be vice president of a group that receives funding from the drug industry. But, he does not disclose this fact in this review in THE NEW YORK POST.


BILL MOYERS: Now, what does that say?

MELODY PETERSEN: This is what they do over and over again. The drug companies are very good at putting their words in the mouth of someone who looks independent to get their message across.


MELODY PETERSEN: responded to Goldberg's attack in THE NEW YORK POST with a letter that alerted readers to the fact that Goldberg was not the objective reviewer they were led to believe. Her letter ends: "The drug companies learned from the tobacco industry that the public would believe their message if it came from someone who appeared independent. People need honest information about medicines, not propaganda."

BILL MOYERS: Doctors, themselves, she writes in her book, can be part of the propaganda machine

MELODY PETERSEN: Unfortunately physicians have lost their way. And I don't think the public really understands this. But, in 1951, Congress changed the law so that we would require prescription for certain drugs. Before, we could go into the drugstore and get whatever we wanted. And Congress wanted an educated physician who had the best interest of his patients at heart and was independent from the pharmacies and the drug companies to be the gatekeeper. But, now, a lot of the physicians in America take gifts or cash from the drug companies. Some physicians take hundreds of thousands of dollars a year.

BILL MOYERS: Congress, too, is in the grip of the industry. Petersen reports that in a recent six-year period Big Pharma spent more on lobbying than any other industry and now employs two lobbyists for every member of Congress. With doctors and congress compromised, what about that other gatekeeper, the Federal Drug Administration?

MELODY PETERSEN: Actually, the drug industry pays the FDA too. There was a change in the law in 1992. Before 1992, the FDA had one customer and that was us, the public. But, in '92, the drug companies started to pay fees to get their drugs reviewed and approved. And so, the FDA has another customer now, the drug companies. And you can talking to scientists inside the FDA, you learn that there's an awful lot of pressure for the FDA to do what the industry want them to do.

BILL MOYERS: So after her exhaustive diagnosis,

MELODY PETERSEN: has some prescriptions of her own.

MELODY PETERSEN: The system is so out of whack the way it is today, you really have to be careful. Don't take any drug without understanding the risks that it could have. Find the doctor who has thrown the sales reps out of his office, who has said 'I'm gonna do what's right for my patients'. And there's a growing number of doctors who feel that way and think the thing that could do the most good is to have a law that bans doctors from taking money from drug companies. We need our doctors to be our independent advocates again.


BILL MOYERS: Melody Petersen thank you for joining me on the JOURNAL.

MELODY PETERSEN: Thank you so much for having me.

BILL MOYERS: Just last week, Congress opened hearings on the marketing practices of Big Pharma. Committee Chair Bart Stupak echoed Petersen's warnings about the dangers in his opening remarks.

REPRESENTATIVE BART STUPAK: The purpose of this hearing is to examine the potentially misleading and deceptive tactics used in direct to consumer advertisements for prescription pharmaceutical products. Research shows that some DTC advertising results in patients seeing their doctor and discussing previously undiagnosed conditions.

BILL MOYERS: Lawmakers were shown television ads from such blockbuster medicines as LIPITOR and VYTORIN, both widely prescribed to lower cholesterol. Industry executives defended the ads as "educational" or as a conversation starter for physicians and their patients. Experts from the American Medical Association and others described them as deceptive, designed to sell a product -not to inform consumers. More hearings are scheduled. In the meantime, read Melody Petersen's book. Then keep it in your medicine cabinet.