BOOK REVIEWS including the LANCET : Selling Sickness: How the worlds biggest drug companies are turning us all into patients by Ray Moynihan & Alan Cassels.

1) Selling Sickness: How the worlds biggest drug companies are turning us all into patients
by Ray Moynihan & Alan Cassels.

Thirty years ago, Henry Gadsden, the head of Merck, one of the world’s largest drug companies, told Fortune magazine that he wanted Merck to be more like chewing gum maker Wrigley’s. It had long been his dream to make drugs for healthy people so that Merck could “sell to everyone.” Gadsden’s dream now drives the marketing machinery of the most profitable industry on earth. Drug companies are systematically working to widen the very boundaries that define illness, and the markets for medication grow ever larger. Mild problems are redefined as serious illness and common complaints are labeled as medical conditions requiring drug treatments. Runny noses are now allergic rhinitis, PMS has become a psychiatric disorder, and hyperactive children have ADD. When it comes to conditions like high cholesterol or low bone density, being “at risk” is sold as a disease. Selling Sickness reveals how widening the boundaries of illness and lowering the threshold for treatments is creating millions of new patients and billions in new profits, in turn threatening to bankrupt health-care systems all over the world. As more and more of ordinary life becomes medicalized, the industry moves ever closer to Gadsden’s dream: “selling to everyone.”

Praise for Selling Sickness:

“a compelling case” – New York Times

“forceful and well-written” – Los Angeles Times

“a welcome, bitter tonic” – Journal of the American Medical Association


2)Selling Sickness - How the World's Biggest Pharmaceutical Companies are Turning us All into Patients.

Selling Sickness tracks the sales and promotional strategies of drug companies based in the United States, Australia, Europe and Canada over the last 10 years. I was drawn through the 12 chapters in this book by my interest in the range and inventive
strategies multinational pharmaceutical companies, public relations and marketing companies and some doctors have used to significantly change the behaviour of both doctors and consumers across Australia and across the world.
 
It is through a number of common 20th century health concerns such as high cholesterol and osteoporosis that the authors demonstrate how we are ‘sold’ on the need to use medicines to deal with the risk of poor health as opposed to actual illness.
 
Softening-up doctors with free daily doughnuts and coffee, consumer and doctor ‘awareness raising’ campaigns and even creating fake grass-roots consumer groups creatively called ‘astro-turfing’ to develop consumer demand for medicines are some of the approaches discussed in the book.
 
From a personal perspective it has prompted me to question the place of medicines in maintaining my health and to be more skeptical of the latest medical facts and figures presented in the media as news.
 
Overall, I felt the book presented convincing examples that support the idea that growing numbers of people are unnecessarily taking medicines. Now how does that saying go …a pill for every ill or an ill for every pill?
 
Yvonne Solly is the Project Manager of the CHF
Community Quality Use of Medicines Project.
 
Selling Sickness, how drug companies
are turning us all into patients
Ray Moynihan and Alan Cassels
Published by Allen and Unwin 2005
254 pages. $26.96
ISBN 1 74114 579 I
 
Yvonne Solly
B O O K R E V I E W
 
Selling sickness: how drug
companies are turning us all into patients
 
“Just being at risk of an illness has become a disease
in its own right.” Selling Sickness px. Experienced writers and researchers in health and current affairs, Ray Moynihan and Alan Cassels are the authors of Selling sickness, how drug companies are turning us all into patients. Selling Sickness is one of a number of books published recently that gives health
consumers and doctors an insight into how pharmaceutical companies and resourceful marketing companies increase medicines sales by widening the definitions of diseases and disorders and creating new ones, to sell their products.


Friday, January 27, 2006
 
3)Book Review: the Lancet (Medical Journal)
by Anne Holland
Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients
2005
By Ray Moynihan and Alan Cassels (Drug Policy Researcher)


There's something very wrong here, I thought, my feverish 2-year-old in my lap, as we sat in a paediatrician's dingy waiting room one afternoon. Not a single intact children's book to take my son's mind off his misery, but plenty of colourful displays freshly stocked with glossy brochures touting drugs for attention deficit hyperactivity disorder (ADHD).

You'll see this sort of thing in almost any doctor's office in the USA. Zoloft clocks, Paxil pens, peppy pamphlets advising you to 'take charge of your health,' by asking your doctor about this or that medication. All of it much newer than the magazines on offer. And as 'Selling Sickness' shows, this is just the tip of the iceberg. Beneath the surface, there's some much more sophisticated salesmanship going on.

Ray Moynihan, a journalist, and Alan Cassels, a policy researcher, describes the siyuation facing us in ten chapters.  Each one about a different 'sickness' and how the pharmaceutical industry has pushed to widen diagnoses for various conditions, and even in some cases creating them, so more people will take the drugs they sell. Given its lax regulations on drug marketing, the USA figures heavily in the book, but the authors' focus is global in nature.

The book opens with a quote from the former head of Merck, who candidly told Forbes Magazine 30 years ago that he dreamed of being able to 'sell to everyone' by making drugs for healthy people. Using a dazzling array of techniques, and plenty of cash, the industry has come a long way toward making this dream a reality.

Enlisting doctors is achieved from free pizza for medical students to thousands in consulting fees to physicians . using 'opinion leaders' is an essential part of the strategy. But the key is to convince as many people as possible that they need a drug by targetted advertising like the famous and successful biilboard cxampaign for a social anxiety drug at all transport queue destinations after 9/11, it said " if you are feeling anxious here contact your doctor and ask for ......... Millions did. To accomplish this, the industry creates patient advocacy groups for each condition, complete with web sites; launches education campaigns for patients; and enlists celebrities willing to 'share their stories.' What these celebs don't share is that they're getting paid. Media outlets often take the bait, doing their part to raise awareness of these so-called diseases.

Moynihan and Cassels interview physicians free of drug industry influence fighting to get the word out to patients that they may not need 'a pill for every ill' or as one puts it, "an ill for every pill." And the authors close by citing what they see as two hopeful examples: the journal PloS Medicine, which takes no drug industry advertising and doesn't run pharma-funded studies, and the American Medical Student Association, which urges members to eschew free lunches from pharma and all that that entails. Let's hope that by the time my son is old enough for ADHD drugs these forces prevail and that ethical practice re-establishes itself.

posted by Alan Cassels
Thursday, January 12, 2006
Book Review: BC Medical Journal

Book reviews

Selling Sickness. By Ray Moynihan and Alan Cassels. 

This book is a must-read if you or your patients are concerned about the way the prescription drug business works. If you have wondered why the cost of medications in our system has gone from half to more than the cost of physician services over a decade, you’ll find some answers here. The writing style is journalistic without being sensational, has well-supported observations, and is an easy read.

There is a strong British Columbia connection since Mr Cassels is a drug policy researcher at the University of Victoria whom many of us have met or heard speak on drug issues. Some of the examples given in the book are very familiar, including references to activities of the Therapeutics Initiative, the work of some BC physicians, and several Pharmacare initiatives. Mr Moynihan is an Australian medical journalist who has written in the Lancet and the New England Journal of Medicine.

The focus is on the myriad avenues through which “big pharma” constantly influences every facet of medication use—marketing, regulation and policy, upward cost pressures, research, guideline development, and the seduction of physicians with money, peer pressure, prestige, and trinkets.

Serious questions are raised that our profession should be asking itself about the reluctance to establish stronger ethical boundaries with the pharmaceutical industry, regulation of financial relationships with sellers, acceptance of financial incentives, and frank conflict of interest. Material is drawn from several countries’ experiences and it reveals the cost of shrinking government support for research and evaluation; it leaves drug development to an industry that aims to fund only what might increase sales.

The chapter titles are descriptive: Selling to Everyone (Cholesterol, the Ads), Working with Celebrities (Menopause and the Public), Making Risks into Medical Conditions (Blood Pressure), Advertising Disease (Premenstrual Dysphoric Disorder), Taming the Watchdogs (IBS and the FDA), and so on.

The information in this book confirmed many things I had suspected. Physicians reading this book should recognize big pharma’s influence on the provision and cost of services and increased testing and office visits. The overlap from consumer advertising in the United States to the Canadian system and the number of patients sent to physicians’ offices specifically to request products they have been “sold” are further evidence of the industry’s sway.

The impact of siphoning billions of dollars away from other service needs, including physician services, and how we as a profession play a role in the uncontrollable rise in pharmaceutical costs are examined.

This is a timely book and I recommend it to anyone concerned about the bigger picture in health care. It makes clear that leaving our fate to the marketplace is risky and expensive and not necessarily a good thing for our patients’ health or our health care system.

—David Blair, MD
Victoria