Profits before People?

Cover

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Contents

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pp. vi-vii

Acknowledgments

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pp. ix-

I am indebted to many individuals for supporting this project and for assistance in completing the manuscript, including Robert Hall, Carol Bayley, Michael McManus, Jessica Seck, Margaret Weber, and Gloria Albrecht. Thank you. I am particularly grateful to Thomas Schindler for repeated and careful...

Introduction

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pp. 1-8

“It has all gone terribly wrong for the dozen or so manufacturers that make up ‘big pharma.’” This statement introduced a review of the pharmaceutical industry’s problems in a March 2005 article in The Economist.¹ The once well-respected drug companies are now being subjected to fierce criticism...

PART ONE: THE LIMITS OF COMMERCIAL INTERESTS

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pp. 9-

1. Ethics and For-Profit Business

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pp. 11-23

Knowing how to relate ethics and the financial bottom line is one of the biggest challenges facing all who seek to manage a business responsibly. Neither ethics education nor business education has, it appears, adequately prepared most people to include dollars comfortably and skillfully in ethical discernment and to...

2. The Pharmaceutical Industry and Its Stakeholders

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pp. 24-33

One of the most important developments in business ethics in recent years has been recognizing the importance of stakeholder analysis in determining ethical responsibility. “Stakeholders” are identified as those who have something at stake in a company’s “products, operations, markets, industry, and outcomes.”² They are “persons and groups that stand to benefit from, or be harmed ...

PART TWO: MARKETING TO HEALTHCARE PROFESSIONALS

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pp. 35-

3. Drug Companies and Healthcare Professionals: The Ethics Agenda

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pp. 37-52

My experience was probably similar to that of many others. I went with a patient to a doctor’s appointment a couple of years ago. As we sat, I began to pay careful attention to what was taking place in the waiting room. Centered in the room was a television featuring a series of short educational programs on health-related topics. ...

4. Medical Professionalism and Scientific Integrity

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pp. 53-65

In an essay in The New York Times, Abigail Zuger provided an example of a physician’s prescribing behavior being influenced by exposure to pharmaceutical marketing. She tells the story of a physician friend. He is someone who deplores the extent to which such marketing has affected the prescribing habits of colleagues but...

5. The Industry’s Code: Not Good Enough

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pp. 66-81

The “PhRMA Code on Interactions with Healthcare Professionals,” published in 2002, is a very significant document. It represents an acknowledgment, on the part of the industry, that laws and governmental regulations are not sufficient to provide full guidance to what is good ethical practice. It is a recognition, in effect, that some of the concerns that have been raised about marketing...

6. Drug Samples: The Most Important Gifts

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pp. 82-92

Central to the techniques used in marketing pharmaceuticals to healthcare professionals is the practice of providing samples of prescription drugs. Thousands of company sales representatives make frequent visits to physician offices and routinely leave samples of medications. Having them available in their offices, physicians can and do distribute these medications to patients. The practice...

7. Marketing Is Not Objective Education

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pp. 93-105

Every year, practicing physicians receive a free copy of the Physicians Desk Reference (PDR), the reference that most of them make use of as a source of drug information. “Overall, doctors refer to the PDR 265,000,000 times a year.”² The information in the PDR is written by drug companies and the companies support...

8. Medical Education: Industry at Arm’s Length

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pp. 106-118

It is a most interesting arrangement, one that many of the public are unaware of and one that most physicians take for granted: much of the CME that is required for physicians in order to maintain their medical licenses is paid for by pharmaceutical companies. CME is mandated for physicians in order to assure...

9. Clinical Research and the Limits of Commercial Interests

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pp. 119-139

In an editorial in JAMA, Bruce Psaty and Drummond Rennie considered the ethical legitimacy of the decision on the part of a sponsor to stop a clinical trial before sufficient data were gathered to yield scientifically valid results. The early termination of a comparative investigation of different treatments...

PART THREE: MARKETING TO THE PUBLIC

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pp. 141-

10. Citizens and Consumers

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pp. 143-156

Americans widely believe and are frequently told by political leaders that “we’ve got the best health care system in the world.”² How good a country’s healthcare system is can be determined, in part, by the health of the population. To measure a country’s health, the World Health Organization (WHO) developed an indicator of “healthy life expectancy,” which...

11. Direct-to-Consumer Advertising: Conflicting Interest

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pp. 157-169

In December, 2004, Pfizer suspended its advertising of the pain reliever Celebrex on radio, on TV, in newspapers, and in magazines. This decision, made in conversations with the FDA, followed the release of study results which suggested an increased risk of heart attacks in patients who took high dosages of Celebrex. Pfizer’s decision on DTC advertising...

12. Direct-to-Consumer Advertising: Better Is Better

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pp. 170-181

In October 2004, the Prescription Access Litigation Project (PAL) filed a lawsuit under California’s Unfair Competition and False Advertising Laws against AstraZeneca. AstraZeneca makes and markets Nexium, a proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD), often called acid reflux. PAL litigates against what it...

Conclusion

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pp. 182-184

Pharmaceutical industry leaders often emphasize their investment in research and development and describe their enterprise as research-based or research-driven. Critics, on the other hand, point to the large expenditures drug companies make in marketing their medications and refer to the industry as marketing-driven. I have ...

Notes

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pp. 185-197

Index

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pp. 199-206