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Melody Petersen has provided a furious indictment of the pharmaceutical industry in Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. Her passionate investigation into the creation of medicines to treat faux problems--physical and mental--should give all Americans pause as we contemplate the future of business regulation in the light of the collapse of the banking industry. Petersen provides a clarion call for significant oversight of the drug companies through her well-researched book. Anyone who takes prescription medication, or knows someone who does--and this, of course, is all of us--should read this book and take up Petersen's cry to battle in the Epilogue.Petersen, a former reporter for the New York Times, outlines with damning detail the efforts of Big Pharma to make billions of dollars on the backs of hapless Americans while ignoring medical conditions that truly need intervention. For instance, Petersen discusses the phenomenon of "me-too" drugs. Big Pharma, she asserts, is looking for "mega-blockbuster" drugs, medicines that will allow huge profits. Clearly Big Pharma does not want people to be cured; curing medical problems reduces income, after all, since a cured person does not take medicines. So the drug companies create conditions for which a drug just happens to be a cure, while ignoring the true needs of the country and the world.For instance, Petersen discusses cholesterol-lowering drugs. She demonstrates Bayer's shocking behavior as it marketed its statin, Baycol, in the late 1990s. Bayer, she says, wanted a piece of the statin market (p. 165), and it did whatever it could to get its market share. Part of what Bayer did was bury the increasing number of reports of rhabdomyolysis, a condition that affects the kidneys, sometimes causing paralysis or death. Instead of acting responsibly, Bayer kept marketing Baycol--until the FDA stopped it. Baycol was a me-too drug that was not necessary, given that there were plenty of other statins around. But, Petersen demonstrates, Bayer determined that its bottom line was more important than its customers' health. Similarly, Petersen details the efforts of Novartis, creator of Ritalin, to restore its market share after generics became available. Other drug companies were able to reformulate the basic chemistry of the stimulant used to "treat" ADD and ADHD so that a child could take only one pill a day, instead of the several Ritalin "required" to get him through school. Novartis also monkeyed around with Ritalin to produce Ritalin LA--long acting--and, further, to increase the number of young people diagnosed with ADD and ADHD so that market share could be increased. So Novartis began telling doctors that not only were disruptive boys dealing with ADD and ADHD; so were quiet girls (208). Ritalin LA was the best thing for both. Unfortunately, it turns out that Ritalin LA has not actually been rigorously studied, and the studies that have been done have either been doctored by the drug companies or demonstrate pretty convincingly that Ritalin's long term effects are unknown and potentially quite harmful.Petersen discusses as well the drug companies' invention of "serious medical issues" that did not exist before. For example, the drug maker Pharmacia essentially made up "overactive bladder" disease, according to Petersen, because they had an incontinence drug, Detrol, that didn't have big enough sales. So, unlike Edward Cole (Jack Nicholson's memorable character in the movie "The Bucket List"), who advises his friend never to pass up the chance to use a bathroom, Pharmacia insists that such behavior constitutes a bona fide illness requiring pharmaceutical treatment, probably for the rest of the patient's life. What Pharmacia doesn't tell us, according to Petersen, is that Detrol is associated with significant and life-threatening side effects, including dementia (47). Instead, Americans who use the bathroom "too much" (however that is defined) need a drug to deal with voiding their bladders. This is hardly an example of life-saving work on the part of drug companies.Petersen also describes in great and horrifying detail the cooptation of America's physicians by the pharmaceutical companies. By paying for "continuing education" at exotic locales, Big Pharma influences doctors unduly to prescribe their drugs. Petersen provides example after example of our nation's doctors accepting payments from drug companies--big payments, payments that in effect double doctors' incomes--who track what doctors prescribe. Big Pharma, moreover, takes doctors to dinner, sends them on trips, and ghostwrites allegedly scientific articles promoting one company's drug line, paying doctors to attach their names to those articles. Petersen's gaze is a bit more forgiving when looking at physicians, though her outrage is clearly simmering below the surface.What Petersen demonstrates throughout this book is the cynicism, greed, and immorality of the marketeers of Big Pharma. The unregulated pharmaceutical industry has one aim, according to Petersen: profit at the expense of actual sick people. Petersen shows that Big Pharma's continual assertions that drug development and research is expensive is a lie. What is expensive, according to Petersen, is marketing. Big Pharma's insistence on "me-too" drugs, rather than original research and development of drugs that are needed across the globe, and its aggressive selling of unnecessary products (using, sometimes, trusted public figures in subtle ways), has created a perfect storm of drug-resistant bacteria, deaths, and huge profits for a small group of people. Petersen's book is well-researched and smartly written. It is a bit repetitive at times--one gets the sense that she did not write a book so much as put together a number of articles she has written--and she does not provide much of an analysis as to why Americans have been duped so easily by Big Pharma. She seems to minimize American culture, by and large, and our growing insistence on leading discomfort-free lives--in other words, Americans' agency and our choices are not paid much attention here, though they are mentioned now and again. That being said, however, Our Daily Meds is a frightening and an important book, one that the next Presidential administration would be wise to heed as it structures the FDA and considers reforming health care in this country.© 2008 Elizabeth A. Throop
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