A Legal Culture of Drug Pushing-"Bitter Pill" Awards Announced Yesterday

As a follow up to my last post and to Cervantes post on Stayin Alive I had the pleasure of participating in a nationwide conference call yesterday during which PAL=The Prescription Access Litigation Project announced the 2006 "Bitter Pill" awards.

This year Bitter Pill Awards were presented in four categories to drug companies engaging in over-zealous and questionable marketing practices. The drug industry’s national lobbying group, PhRMA, received two awards, and the remaining three awards were shared among makers of five of the nation’s most well-known drugs: Lunesta, Ambien/AmbienCR, Lipitor, Crestor and Strattera.

PAL uses highly creative humor as an effective weapon. For example awards included "The While You Were Sleeping Award" (the dangerous boom in insomnia meds sales), "The Got Cholesterol Award"(excessive and dangerous statin meds use),"The Driven to Distraction Award" (for overdiagnosing ADD and hawking ADD drugs to dangerous excess), and two awards to the Drug Industry's own extremely wealthy and powerful lobbying group= PhRMA-"The Fox Guarding the Henhouse Award" (for pushing voluntary rather than mandatory drug advertising standards), and "The Truth is Stranger Than Fiction Award" (for scaring Americans about the trumped up dangers of Canadian Drugs)

I was surprised to learn during the conference call that, of all people, Sen Dr. Bill ("how to otherwise destroy US Health Care") Frist actually supports much stronger legislation to reign in overzealous unscrupulous drug company marketing. Live and learn about strange bedfellows?

Also one pet peeve (err- rage?) of mine not addressed by this oustanding PAL effort -they can't/shouldn't do everything- is the depiction of smiley people on TV ads literally pushing over-the-counter (OTC) drugs onto neighbors, friends, co-workers and family members by saying "here try this" for your pain, etc. Hey, as PAL says, drugs ain't exactly recommending a good restaurant or digital cameras.

Anyway this outstanding organization, now only in its second year of presenting awards, is to be resoundingly commended for using humorous and creative methodologies as well as serious legal and educational actions to tackle a truly pernicious practice almost unique to American Culture. Most other countries have banned direct to consumer (DTC) advertising of prescription medications. But the good Ole US of A can't seem to break its sick addiction to "the free market solves all human problems" approach to almost everything.

About the Prescription Access Litigation Project (PAL)
Prescription Access Litigation Project (PAL) (www.prescriptionaccess.org) is a project of Boston-based Community Catalyst. PAL is a nationwide coalition of 118 state, local, and national senior, labor and consumer health advocacy groups in 35 states fighting to make prescription drugs affordable. The organizations in the PAL coalition have a combined membership of over 13 million people. PAL works to end illegal drug industry practices that increase the price of prescription drugs beyond the reach of the American consumer, using class action litigation and public education. Since 2001, PAL members have filed 26 sets of lawsuits targeting such practices.

Note: A complete electronic press kit, containing graphics, is available at www.bitterpillawards.org.

Dr. Rick Lippin (Blake)

Drug Coupons = Legalized Drug Pushing-Pure and Simple

Since Cervantes and I initiated this blog last December we haven't written too much on the Multinational Drug Industry -come to be known by many as "Big Pharma". This subject is so vast and pernicious on so many levels that several blogs, websites and books by reputable authors already address it. Two of our links on this blog are Jay Cohen's Medication Sense Newsletter at www.medicationsense.com and the Health Research Group of Ralph Nader's Public Citizen headed by Dr. Sidney Wolfe.

Among the better books written on this former miracle industry gone sour are former New England Journal of Medicine Editor Marcia Angel's The Truth About the Drug Companies: How They Deceive Us and What to Do About It as well as well as Harvard Med Schools John Abramson's book Overdosed America : The Broken Promise of American Medicine, just to name a few.

Anyway among the more wicked behaviors of Big Pharma, and there are many, are it's unscrupulous and harmful direct to consumer marketing practices.

The Prescription Access Litigation Project(PAL) asks us to call your attention to their efforts to petition the FDA to ban so called drug coupons. PAL says:

Consumer Advocates Call on FDA to
Ban Prescription Drugs Coupons

Today, April 6, 2006 the Prescription Access Litigation Project (PAL)-a project of Community Catalyst-joined with 22 other consumer advocacy groups in calling for the Food and Drug Administration (FDA) to ban pharmaceutical companies from using so-called drug coupons in their vast direct-to-consumer advertising promotions. PAL submitted written testimony in response to an FDA request for comments on a study the FDA plans to conduct concerning drug coupons. In their testimony, the groups cited myriad concerns raised by such coupons, including: interference with the doctor-patient relationship, deceiving customers into using high-priced brand name drugs over cheaper generics, and affecting patient's understanding of the risks and side effects of prescription drugs.

"Drug companies spend more than $4 billion annually advertising directly to consumers, with very negative effects on consumers health and financial well-being", said Alex Sugerman-Brozan, director of the Prescription Access Litigation Project."Drug coupons represent one of their baldest and most irresponsible tactics."

Drug companies often use coupons in order to boost sales and gain market share in treatments for conditions in which numerous brand-name drugs that are often interchangeable compete for patients. Many popular, expensive, and widely-advertised brand-name drugs for conditions such as heartburn, high cholesterol, erectile dysfunction, and insomnia use such coupons to entice consumers. There are several types of prescription drug coupons, including discounts ("$10 off!"). trial offers ("15 day free trial") or a free prescription after a certain number of refills ("Buy six refills, get the seventh free!"). Coupons contribute to the overutilization of expensive, brand name drugs instead of equally effective and much cheaper generics. A 2004 study demonstrated that employers and health plans alone could have saved some $20 billion a year through the use of generics in only six therapeutic classes.

"Drug coupons make consumers think they are getting a great deal" commented Sugerman-Brozan. "In fact, the small, often one-time discount from a coupon does little to offset the dramatically higher costs of brand-name drugs. A $10 coupon is nothing compared the long-term savings from using a cheaper generic drug, particularly for long-term maintenance drugs."

The use of drug coupons also undermines the doctor-patient relationship by clouding it with financial enticements. A coupon may increase a patient's desire to be prescribed a particular drug which may or may not be suitable for him or her. Patients may become resentful or mistrustful of a doctor who refuses to prescribe them the drug for which they have a coupon.

"Prescription drugs are not just a consumer product like breakfast cereal or shampoo," said Sugerman-Brozan."But using coupons to sell drugs treats them like they are. Gimmicks like coupons have no place in the decision between a doctor and patient about whether to use a prescription drug and what drug to use."

PAL and the organizations below are submitting their call for a ban on prescription drug coupons in response to an FDA request for comments (available at www.fda.gov/ohrms/dockets/dockets/06n0029/06n-0029-n000001.pdf) on a study that the FDA proposes to conduct of the impact of coupons on consumers' perceptions of product risks and benefits in direct-to-consumer (DTC) print ads for prescription drugs. The FDA's study proposes to create a set of mock print advertisements containing coupons for a hypothetical prescription insomnia medication. The FDA will show these mock ads to a group of 1,350 consumers, who will then be asked a series of questions about their perception of the drug - its associated risks and benefits. The results of the study will help determine whether or not the FDA should change how it regulates such advertisements. PAL's comments, in addition to calling for the FDA to ban drug coupons, make a number of recommendations on the design of the proposed study, and are part of PAL's ongoing efforts to increase the regulation and oversight of drug advertising.

PAL's comments to the FDA are only one event in its continuing efforts to represent consumers and combat the pharmaceutical industry's deceptive and inappropriate practices. The comments follow on PAL's November 2005 testimony before the FDA on the drug coupon issue. On Wednesday 26 April at 2 p.m. Eastern, PAL will present its second annual Bitter Pill Awards .

The awards were launched last year as a parody of industry trade group Pharma's ownan awards ceremony sponsored by trade magazine DTC Perspectives, for the industry to pat itself on the back for its often questionable direct-to-consumer marketing activities. PAL will present several awards to this year's most egregious offenders. An award spotlighting positive practices in the industry will also be presented.


PAL is joined in its call for a ban on Rx drug coupons by:
· Action Alliance for Senior Citizens (Philadelphia, PA)
· American Federation of State, County and Municipal Employees (AFSCME) (Washington, DC)
· The Annie Appleseed Project (Delray Beach, FL)
· Connecticut Citizens Action Group (Hartford, CT)
· Congress of California Seniors (Sacramento, CA)
· Consumers for Affordable Health Care Coalition (Augusta, ME)
· Consumers Union (Washington, DC)
· Gray Panthers California (Sacramento, CA)
· Health Care for All (Boston, MA)
· JPAC for Older Adults (New York, NY)
· Long Island Health Access Monitoring Project (Great Neck, NY)
· Massachusetts Breast Cancer Coalition (Quincy, MA)
· MassPIRG (Boston, MA)
· Massachusetts Senior Action Coalition
· Metro New York Health Care for All Campaign (New York, NY)
· Minnesota Senior Federation (St. Paul, MN)
· New York Statewide Senior Action Council (Albany, NY)
· Tennessee Health Care Campaign (Nashville, TN)
· United Senior Action of Indiana (Indianapolis, IN)
· Utica/Central New York Citizens in Action (Utica, NY)
· U.S. PIRG (Washington, DC)
· Wisconsin Citizen Action (Madison, WI)

PAL's testimony to the FDA is available at www.prescriptionaccess.org

I'll just add that in July of 2002 your's truly (Blake) circulated my anonymous 9 point forecast about major trouble ahead for Big Pharma in which I stated that current marketing practices had transformed Drug companies into legal drug pushers - pure and simple- perhaps worse than the street corner pusher because Big Pharma has the power and $ to be responsible.

Please support PAL in getting drug coupons banned by the FDA. This is long overdue and is one of many good initiatives attempting to rectify one of contemporary western medicine's greatest tragedies- the excesses of the multinational drug companies born out of unbridled greed.

Stayed tuned from Cervantes and myself on Big Pharma issues both here and atStayin Alive.

Guest Post from Tor Dahl

We're pleased to offer this astute critique of market fundamentalism in the health care policy debate from economist Tor Dahl, President of Tor Dahl and Associates. Dr. Dahl extends and improves upon some ideas I offered here earlier in my post Lost in Space. It's very important that we all get this because most of the people who pass for journalists these days don't, and the politicians either don't get it, or want to fool us.

This is an edited version of a longer article originally published in Dr. Dahl's newsletter, and we thank him for permission to repost it here.

-- Cervantes

The fact is that markets don't work in health care. And it is not only because some people cannot afford it. Here is why:

1. Where there is demand for something for which there is no supply, markets don't work.

The classic example is that of a lighthouse. It cannot collect from those it serves, and would not exist unless and until some entity were to finance the expense of building it.

People living in a geographic area that is under-served by health care are a bit like ships in need of a lighthouse, aren't they?

2. Where there is a supply of something for which there is no demand, markets don't work.

The classic example here is that of pollution. Pollution also directly affects our health and, potentially, our survival as a species.

3. Where there is a monopoly, markets don't work.

The monopolist controls supply of a good or a service and, hence, is free to set price, there being no countervailing power. Examples abound in health: Patent protection for drugs, the scarcity of certain medical sub-specialists, quotas for students entering medical school. In a sense, every nearby health care facility enjoys some monopoly power if no other facility is available in an emergency.

4. Where there is monopsony (one buyer and many sellers), markets don't work.

A national health care system, where a government agency has the sole right to buy drugs for its clients, is an effective monopsony. In the U.S., the Veterans Administration has the power to buy drugs for all veterans and can, thus, negotiate effectively with pharmaceutical companies that have monopoly power. Medicare does not yet have this right, but will likely receive it if costs of drugs continue to rise at the same pace as in recent years.

5. When there are externalities, markets do not work.

In this case, the classical example has to do with the benefits that derive from vaccinations. They extend well beyond those who receive them, since the likelihood for all to be exposed to contagious disease is diminished by the actions of some. This is a positive externality. The spread of bird flu is an example of a negative externality when vital food distribution channels can turn deadly.

There are even more reasons why market forces don't work in health care. Markets only work where there is competition, and effective competition requires perfect information, many small sellers and buyers, no transportation costs, and perfect knowledge. None of these conditions exist in health care delivery. Hence, competition and free markets cannot exist in health care, except in a very limited and narrow sense. That does not mean that we cannot use markets as a distribution mechanism where they can be made to work, e.g. in the sale of over-the-counter drugs and in other cases when people have the funds to pay for their healthcare needs.

But when markets break down, we have to find other ways of supplying health care. Each of these has a cost. To find the least cost solution with the highest benefit seems to be the best way. We are beginning to understand how we can make this happen.

Productivity and quality are key tools in that picture. The chance of ending up with high-cost/high-mortality care once cancer is detected is about equal to the chance of ending up with a low-cost/low-mortality care, says Dr. William McGuire, CEO of the United HealthCare Group. We must solve this problem! The information tools now available would go far in helping the health sector improve the quality of care and perform better. They will allow us to find these islands of excellence within the system, steer patients towards them, and point the way for necessary improvements throughout the health sector.

Mental Health Insurance Parity- An Imperative

I know all the studies don't justify complete insurance parity for mental health services but a recent post by Cervantes in Stayin Alive Blog "A slightly puzzling result..." (April 3, 2006) http://healthvsmedicine.blogspot.com reminded me that I wanted to put forth a few of my views on this topic. For disclosure purposes I am not a trained Psychiatrist although my only honors in med school were in my Psychiatry rotation. I capitalized on my passion for mental health issues by becoming a leader in my chosen field of Occupational Medicine in the areas of work stress and what NIOSH (the research arm of Occupational Medicine) calls Organization of Work (OOW) . I was the only physician who consulted to NIOSH on it's OOW research team.

Well-"Enuf braggin". But as a practicing physician it became very apparent to me very early on that the prevalence of mental health issues was grossly underdiagnosed and went grossly un or undertreated in part because of lack of coverage by insurance companies.

I came up with two simple questions that I personally petitioned JCAHO that would require that every primary care physician be required to ask of patients during their very brief time with patients under our failed managed care system. The questions are "How are things at work?" and "How are things at home?". Patients could respond on a 1-10 Likert scale and be treated or referred if an emotional disorder was apparent. But alas JCAHO does not certify out-patient facilities yet.

The incidence of depression, anxiety and other mental health related conditions is well documented and is likely rising due to many reasons I won't go into today (please stay tuned)

Kudos to President Clinton for requiring mental health parity coverage for federal workers in 1999. President Bush has promised he would push for parity legislation. Don't hold your breath though folks. Instead he and Dr. Frist are putting the final nails in the coffin of our dying US Health Care System.

For some enlightened views on the imperative for mental health parity insurance coverage I refer you to the Progressive Policy Institute at www.ppionline.org
and The Commonwealth Fund at www.cmwf.org. Both of these progressive organizations are responsibly trying to lead us into a better US Health Care System. Read them and support them!

If you want material on work stress my favorite site is www.workhealth.org which has many good studies and links.

Also I would be very pleased to forward to any reader my work with NIOSH on Organization of Work (OOW) since not only are there very clear biological causes for serious mental health conditions- without any doubt there are psycho-social causes and contributions- believe me-big time. Just e-mail me at ralippin@aol.com

Thanks for your interest in Mental Health Insurance Coverage Parity. Its comin for all. We have no choice!

Dr. Rick Lippin ("Blake")