BIG PHARMA: How the World’s Biggest Drug Companies Control Illness
by Jacky Law
Constable and Robinson £12.99, 256 pages

SELLING SICKNESS: How Drug Companies are Turning Us All into Patients
by Ray Moynihan and Alan Cassels
Allen & Unwin/Nation Books $25, 272 pages

A couple of years ago an advert appeared on US television during the Academy Awards, urging viewers to have their cholesterol levels tested regularly in the fight against heart disease. It seemed like a praise-worthy public health campaign.

A group called the Boomer Coalition, fronted by Henry “the Fonz” Winkler, urged his fellow baby boomers to take action against “the most talked about disease”. The group’s website, adorned with 1960s images of civil rights marches and peace protests, urged people to “know your numbers”.

What the ad failed to mention was that Boomer was dreamed up by a public relations agency and part-funded by the pharmaceutical company Pfizer, manufacturer of Lipitor, the anti-cholesterol medicine that is the world’s top-selling drug.

It was one example of what health writers Ray Moynihan and Alan Cassels dub astro-turfing, or “the creation of fake grassroots campaigns by public relations professionals and in the pay of large corporations”. In their forceful and well-written book Selling Sickness, the two authors highlight the influence of the pharmaceutical companies in “disease-mongering”.

These companies use powerful images to provoke fear in healthy people or offer a narrowly medical response that downplays diet, exercise and other approaches for those who may be at risk.

The authors study diseases whose medical component and extent they say are exaggerated, including irritable bowel syndrome, female sexual dysfunction and attention deficit disorder. With regard to the last, in some US states up to a fifth of white boys are given prescription drugs that are essentially legalised amphetamines.

“Having bones with a particularly low mineral density does increase a person’s chance of a future fracture,” Moynihan and Cassels argue in a chapter on osteoporosis, “[but so does] whether there are loose mats in your house and whether you might need better glasses.”

The critique is nothing new. Jules Romain’s play Dr Knock, about a doctor who practically turns his village into a hospital, premiered in Paris in 1923. More recently, the German journalist Jorg Blech charted the trend in his book The Disease Makers in 2003. Since then, half a dozen anti-pharma tomes have been published in the US.

That is not surprising. Nowhere are the tools of influence more honed or the money greater than in the US. Moynihan and Cassels have done a good job in highlighting cases there, while sometimes artificially tacking on a few Australian and Canadian examples as a concession to their respective nationalities.

Big pharma, they argue, is implicated at every level, from giving out free pizzas and doughnuts to junior doctors, through the billion dollars a year spent on continuing medical education, to sponsored research and funding for “key opinion leaders” who write influential articles and draft professional treatment guidelines.

The pinnacle of their influence is the $3bn spent annually on direct-to-consumer advertising of medicines, defended by the pharmaceutical industry as a way of keeping patients informed, and which encourages patients to press doctors to prescribe new drugs with often questionable benefit. The process is helped along by marketing advisers such as Vince Perry, who boasts of “the art of branding a [medical] condition”.

The authors do not find any explicit cases of pharma money exchanged for influence in support of patient groups, often vocal defenders of new drugs. Instead, they describe a process that is subtle, involving a “confluence of interests” between pharmaceutical groups and under-funded and generally well-meaning charities.

However, while quoting experts for and against each of the fast-growing disease areas that they discuss, the authors fail really to explore the underlying science in a way that would allow the reader to better judge where the balance lies. They also underplay the positive contribution of modern pharmaceuticals, which in recent years have offered extraordinary progress in areas such as cancer treatment and the transformation of Aids from a death sentence into a chronic disease.

Jacky Law’s Big Pharma launches a broader attack on the industry in a less convincing or digestible form than Selling Sickness. Law’s basic thesis is the need for greater patient power. In recent years some people taking the anti-depressant drug Seroxat have reported suicidal tendencies and Law applauds the fact that safety warnings are now being heeded. But she ignores the silent majority who have benefited from the treatment.

Was the drop off in MMR vaccinations really the result of growing public disillusion with regulators, as Law suggests? The media, including the highly respected medical journal The Lancet, also gave credibility to supposed reports of side effects - now widely discredited.

Law rightly touches on the crisis in research and development by the big companies, the risks of unknown side effects of drugs and the importance of the placebo effect. But it is difficult to draw out a coherent message from her writing.

Both books skirt recent attempts at reform, from a shift towards more nuanced consumer advertising of medicines, to the growing role of head-to-head trials designed to test how far new drugs really do outperform existing ones.

The authors criticise the status quo strongly, without proposing realistic alternatives. What emerges - as a minimum necessity - is that clinical trials should be more objective, more widely available and more understandable. They should also be framed in the context of the relative risks and benefits of medicines and disease.

Andrew Jack is the FT’s pharmaceuticals correspondent.

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