Declaring war on drug companies

Jeffrey Robinson regards the pharmaceutical industry marketing machine as "evil". It's the sort of target he likes because every year, for the past 20 years, he has had to come up with an idea for yet another sensational, best-selling non-fiction book. This earns the affable and charming 54-year-old American journalist enough money "to keep my French wife", to pay the fees for his French-American children at the Lycee in London and to support a globe-hopping lifestyle with bases in three countries. The test of a successful "Robinson" is simple: he can do the writing and research in a year, he can talk passionately about the subject on TV and radio and he can get other journalists interested in writing about it.

Robinson's latest, Prescription Games: Money, Ego and Power Inside the Global Pharmaceutical Industry, is such a book. Even better, a lot of the research was already done by US consumer watchdog groups. On top of that, it's all in a good cause: educating the consumer to demand more ethical behaviour of pharmaceutical companies.

And there's a built-in rescue clause in case anyone accuses Robinson of a lack of objectivity. He told The Irish Times that one pharmaceutical company has already threatened to "get him", which it will do - he alleges - by planting media stories questioning his claims.

His subject is the "amoral" behaviour of Big Pharma, an industry of 75-odd research-based drug companies. A few examples of the evidence: they fund two lobbyists per politician on Capitol Hill. In the US, they spend $13,000 per year per doctor on salespeople, junkets and promotions that threaten to pierce doctors' objectivity.

They invest billions of dollars in developing lifestyle drugs for impotence, hair loss and obesity in the West, while failing to develop drugs for the millions of Third World people dying from diseases such as malaria, cholera and dengue fever. They limit access to drugs and keep costs up by fiercely protecting their patents. Their relationship with the US Federal Food and Drug Administration can be so incestuous that FDA employees have been caught taking bribes to push through certain drugs and hamper the progress of others.

Robinson says he admires the work of scientists in research and development, but that these are "good people working in an evil industry".

"Demonising the industry and its employees in this way is unfair to the industry itself and offensive to the 14,500 people in this country who have dedicated their working lives to it," responds Ann Nolan, CEO of the Irish Pharmaceutical Healthcare Association, which represents pharmaceutical companies. "Such demonisation may also undermine patients' confidence in their medicines, which could in turn lead to further reduced levels of compliance."

Robinson is also critical of much of the medical profession for its cosy relationship with drug companies.

Nolan responds: "In Ireland, there is no scope for unethical behaviour because the relationship between the pharmaceutical industry and the medical profession is strictly controlled through the law and through codes of practice. Conference trips funded by pharmaceutical companies play a genuine educational role concerning the latest advances in medical science, providing objective information from leading clinicians and experts in the pharmaceutical field." In her view: "Robinson's views lack balance and recognition of the extensive role that the pharmaceutical industry plays in saving lives and enhancing quality of life for millions and millions of people all over the world."

That's the industry line, but a very different picture emerges in Robinson's book about an industry which is known for its secrecy, and which is the most profitable in the world, ranked first in return on assets, profits and equity by Fortune magazine.

"Amoral" is the judgment of Dr Larry Sasich, a pharmacologist with the Health Research Group of the US watchdog organisation Public Citizen, quoted in Robinson's book: "To these guys, drugs are just commodities. They don't look at drugs as something people need in order to live or to make their lives better when they face a disease. For them, drugs are just like a pair of shoes or a tennis racket."

But a lot more expensive. Bringing a molecule from the stage of discovery to a finished drug takes eight to 12 years and costs as much as $300,000 to $500,000.

THE World Health Organisation has maintained for years that "there is an inherent conflict of interest between the legitimate business goals of manufacturers and the social, medical and economic needs of providers and the public to select and use drugs in a rational way".

Drugs are developed only if there is a large enough market of consumers willing to pay, Robinson contends. Cancer, hypertension, psychiatric disorders, osteoporosis, rheumatoid arthritis and thrombosis meet the criteria. So do lifestyle drugs such as Viagra.

Dr Stephen Schondelmeyer, pharmacologist and director of the Prime Institute of the College of Pharmacy, University of Minnesota, claims in the book: "When it's cost effective, they find a cure. The opposite, non-cost effective illnesses, is where there is no economic inventive [sic] for anyone to go find a cure. Where you have rare diseases in developed countries with resources, they're likely to get taken care of. But if you have diseases, even with large populations in Africa, but no resources, people die."

Not always. Robinson tells the story of Roy Vagelos, chairman and CEO of Merck, who fought to have Ivomectin given free of charge in the Third World, thus preventing river blindness in 25 million people in 1998 alone. But he gives the impression that Vagelos is a hero bucking the trend.

In fact, there are 140 initiatives into diseases in developing countries. Among them is one in which Pfizer (which recently merged with Warner-Lamber) has donated $66 million in medicine and grants to eliminate trachoma, the world's leading cause of preventable blindness. Glaxo Smith Kline has donated one billion dollars worth of an anti-parasitic drug, albendazole, to cure lymphatic filariasis. Aventis has donated drugs and funding for educational programmes in the fight against leishmaniasis, at a cost of $60,000.

All this is good PR. Not like the lawsuit being brought by 39 pharmaceutical companies against South Africa - such a PR disaster that one company, Merck, has dropped out. The suit is in response to a new law which negates patent legislation for all pharmaceutical products.

The SA government thinks that by enabling local companies to manufacture drugs patented by the multinationals, less expensive drugs to treat AIDS and other epidemics will result. Nolan disagrees: "South Africa has been a public relations disaster, but the industry will do everything in its power to defend the patent system, because patents lead to profit and profits lead to innovation and innovation leads to the new medicines that will help us all. The industry is not a charity, medical research is not born out of altruism, it is born out of the hard graft of lengthy, expensive and risky scientific research."

The SA government has not accepted offers of cheaper drugs from the pharmaceutical industry in exchange for protecting patents, according to the International Federation of Pharmaceutical Manufacturers Associations (IFPMA). The representative body also alleges that SA government mismanagement has meant that 50 per cent of pharmaceutical products it imports are lost to theft, fraud and mismanagement at state facilities.

The SA problem is a symptom of a greater problem, perhaps summed up by Dr Schondelmeyer, who staunchly believes that drugs are "public goods" in much the same way that public utilities are, or should be (in his view).

"Drugs are in limited supply. That's why we, as a society, grant patents to the companies which discover new drugs because we want to encourage and stimulate innovation. . . If I have a disease that affects the length of my life, I need that drug. If it's in limited supply because that company has a patent, which means no one else can manufacture it, and if I can't afford it, because they have no competition and can charge whatever they want, then the result is that I have a shortened life."

Nolan counters: "Industry alone cannot solve the problem. The problem needs legislation such as that introduced by the EU last year that lessens the cost of research and development, which it does through lower charges for the authorisation process."

Pharmaceutical companies are businesses, like any other, answerable to their share-holders and "deserve to make a profit," she argues. However, drugs are a life-and-death product unlike any other. Limiting accessibility is an emotive issue. Like health insurance companies, drug companies make financial decisions which have emotive repercussions for individual's lives.

Fortunately, in this State we don't have this problem. Every four or five years, the pharmaceutical industry negotiates with the Government to make sure everyone, regardless of ability to pay, has the same access to the full range of modern medicines.

This is unusual, and if Robinson had included this example in his book, perhaps it would have shown that the pharmaceutical industry is willing to work in partnership to make ethical choices. But it's not that kind of book.

Prescrition Games: Money, Ego and Power Inside the Global Pharmaceutical Industry by Jeffrey Robinson is published by Simon & Schuster at £17.99 in UK