Cross posted from The Stars Hollow Gazette

John Oliver opened the second season of HBO’s “This Week Tonight” with a humorous but sobering segment on how big pharmaceutical companies market their drugs to doctors, spending an estimated $24 billion per year in direct marketing.  In his witty but serious way, he explains that 70% of Americans take at least one prescription drug, and spent $329 billion, $1000 per person, on those medications in 2013. John quipped, “Walter White could have made more money cooking up rheumatoid arthritis medication.”

Big Pharma tactics include everything from lunch, to sexy sales reps to expensive dinners with other doctors who pitch the sale as “thought leaders.” The drugs are often pushed for “off label” use, that is, use that the FDA has not approved and most of the reps know very little, if anything, about the drugs that they’re pushing.

Drug companies are like high school boyfriends, they’re more interested in getting inside you than in being effective once they are there.

One a the good things that the Affordable Care Act did is it created a web site, OpenPaymentsData.CMS.gov that which enables average citizens a chance to search for perks given to doctors by pharmaceutical companies.

Cross posted from The Stars Hollow Gazette

The United States and New Zealand are currently the only countries in the world where the pharmaceutical industry is allowed to market and advertise prescription drugs. Direct to consumer advertising is one of two industry practices that have some under fire recently. The other is paying doctors to promote drugs.

One of the biggest market for drugs have been parents concerned about their children’s success in school. Attention Deficit Hyperactivity Disorder (ADHD) is now “the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.”

The Selling of Attention Deficit Disorder

By Alan Schwarz, New York Times

The Number of Diagnoses Soared Amid a 20-Year Drug Marketing Campaign

After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.

Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurological problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic A.D.H.D., helping youngsters succeed in school and beyond.

But Dr. Conners did not feel triumphant this fall as he addressed a group of fellow A.D.H.D. specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable. [..]

Like most psychiatric conditions, A.D.H.D. has no definitive test, and most experts in the field agree that its symptoms are open to interpretation by patients, parents and doctors. The American Psychiatric Association, which receives significant financing from drug companies, has gradually loosened the official criteria for the disorder to include common childhood behavior like “makes careless mistakes” or “often has difficulty waiting his or her turn.”

The idea that a pill might ease troubles and tension has proved seductive to worried parents, rushed doctors and others.

Taken at face value, the latest figures on attention deficit hyperactivity disorder (ADHD) suggest a growing epidemic in the United States. According to the Centers for Disease Control, 15 percent of high school children are diagnosed with ADHD. The number of those on stimulant medication is at 3.5 million, up from 600,000 two decades ago. ADHD is now the second most common long-term diagnosis in children, narrowly trailing asthma.

But a new report in The New York Times questions whether these staggering figures reflect a medical reality or an over-medicated craze that has earned billions in profits for the pharmaceutical companies involved. Sales for ADHD drugs like Adderall and Concerta topped $9 billion in the United States last year, a more than 500 percent jump from a decade before. The radical spike in diagnoses has coincided with a 20-year marketing effort to promote stimulant prescriptions for children struggling in school, as well as for adults seeking to take control of their lives. The marketing effort has relied on studies and testimonials from a select group of doctors who have received massive speaking fees and funding grants from major pharmaceutical companies.

We are joined by four guests: Alan Schwarz, an award-winning reporter who wrote the New York Times piece, “The Selling of Attention Deficit Disorder”; Jamison Monroe, a former teenage Adderall addict who now runs Newport Academy, a treatment center for teens suffering from substance abuse and mental health issues; Dr. Gabor Maté, a physician and best-selling author of four books, including “Scattered: How Attention Deficit Disorder Originates and What You Can Do About It”; and John Edwards, the father of a college student who committed suicide after he was prescribed Adderall and antidepressant medications at the Harvard University Health Services clinic.

One drug company, GlaxoSmithKline, a British owned company, has decided to stop paying doctors to promote their prescription drugs:

Andrew Witty, Glaxo’s chief executive, said in a telephone interview Monday that its proposed changes were unrelated to the investigation in China, and were part of a yearslong effort “to try and make sure we stay in step with how the world is changing,” he said. “We keep asking ourselves, are there different ways, more effective ways of operating than perhaps the ways we as an industry have been operating over the last 30, 40 years?”

For decades, pharmaceutical companies have paid doctors to speak on their behalf at conferences and other meetings of medical professionals, on the assumption that the doctors are most likely to value the advice of trusted peers.

But the practice has also been criticized by those who question whether it unduly influences the information doctors give each other and can lead them to prescribe drugs inappropriately to patients. All such payments by pharmaceutical companies are to be made public next year under requirements of the Obama administration’s health care law.

Under the plan, which Glaxo said would be completed worldwide by 2016, the company will no longer pay health care professionals to speak on its behalf about its products or the diseases they treat “to audiences who can prescribe or influence prescribing,” it said in a statement. It will also stop providing financial support directly to doctors to attend medical conferences, a practice that is prohibited in the United States through an industry-imposed ethics code but that still occurs in other countries. In China, the authorities have said Glaxo compensated doctors for travel to conferences and lectures that never took place.

Mr. Witty declined to comment on the investigation because he said it was still underway.

This piece is a result of a couple of pieces that I have written before and some interaction in comments on pieces from others about prescription drugs advertisements.  They are rife in the popular culture these days, on TeeVee, on radio, and in print.  I really think that this is a horrible idea, and will explain as time progresses.

First, I must do a bit of historical treatment.  When I was in pharmacy school (I did not stay long, because I decided that I should be on the other side of the wall, developing new drugs, but that did not work out either) adverts for prescription drugs were only allowed in professional medical journals.  I mean it.

Those you 50 or older will probably, if you think hard enough about it, days when these drugs were not in the popular media.  Some of you might also recall that tobacco adverts were!  I still remember the jingles for cigars and cigarettes.

I probably shouldn’t pull punches here.  I find some of the rhetoric and claims in this video a bit suspect.

Perhaps the oddest part for me is that the videomaker is using imagery that she considers disgusting at least, while arguing (it seems to me) that the ads for children’s clothing used by American Apparel are somehow pornographic.

Now there’s a part of me that sympathizes with this view.  And then there’s the part of me that thinks… didn’t you just manage to make an unpaid ad for this company by using the same images as part of your critique?  Aren’t you also exploiting these children by showing the images, and not only that, but unlike the company that paid the models and their parents, you’re exploiting them without any compensation.  (Then again, by embedding this and drawing attention to it, perhaps I’m doing the same thing?)

It strikes me as a very slippery slope, to say the least.  Before I sound like a pontiff from a religion that doesn’t institutionalize child sexual abuse, let me just embed the video I’m talking about, so you can make up your own mind before I continue my rant.

Don’t view the following video if you think it might contain soft-core pron.

copyright © 2010 Betsy L. Angert.  BeThink.org

It happened once, twice; I trust the third time could not charm me more.  I have witnessed the power of a gesture, one made without words.  I have seen the light that glows when people connect in quiet ways.  Now experienced on more than one occasion, I have come to appreciate the peaceful power of consistent communication.  I had not fully acknowledged what could be accomplished until I arrived on the scene, alone.  Then I saw it.  I felt it.  I could hardly believe that a single steadfast individual, could convey a message without words, and still receive such a resounding response.  Yet, while there, it occurred.  I was struck by what had not been apparent for near a decade. The stance of a quiet soul, stated calmly, clearly, and with care, can move more persons than I ever imagined.