Selling Sickness five years on


DRUG BUST by Alan Cassels

It was five years ago this month that Common Ground’s publisher Joseph Roberts asked me to write a column for his magazine. He tracked me down at a book festival at the Vancouver Public Library, as I was about to deliver a talk on my just-released book, Selling Sickness, which I co-wrote with Australian journalist Ray Moynihan. I accepted Joseph’s offer, not really knowing what Common Ground readers were all about and whether or not they would appreciate my perspective.

Little did I know that conversation would result in the monthly column “Drug Bust,” innumerable physicians who both praise and curse me when their patients say, “Look what this guy is saying about cholesterol” and the foundations of a new book. Sixty columns later, I’m still here, facing my five-year anniversary and reflecting on how the world – the pharmaceutical world in particular – has changed since 2005.

For those who haven’t read Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Greystone, 2005), let me recap the main point: the pharmaceutical industry, one of the most lucrative and successful industries in the history of the world, has shaped what we think about illness in order to sell treatments to the healthy and the well. Drug makers are big businesses employing top-flight marketers, prestigious thought leaders and genius tacticians whose goal is to create and sell the pills many of us swallow every day. Along the way, they sell something even more important: our modern notions of sickness and healthcare.

With examples drawn from the marketing tactics Ray and I documented in places like the British Medical Journal and CBC radio over 15 years, we enumerated the many arms of the pharmaceutical industry octopus, whose tentacles slither into places it has no right to be, all the while sucking and groping to give traction to an often lopsided, drug-centric view of modern healthcare.

Let me be clear; modern pharmaceuticals are often the right and most appropriate treatments for what ails many of us. They are frequently underused in patients who would really benefit from them. Ask any asthmatic or diabetic where they’d be without their puffer or their insulin. At times, prescription drugs are truly lifesaving. But they are also often grossly and inappropriately swallowed by many who stand little chance of benefiting from them and who instead are at great risk of real harm. Death by the injudicious use of drugs is common and our swallowing them, in many ways, makes us poorer.

Five years later, my goal in writing that book and this column has never changed: I want to help stoke the global conversation on disease mongering and get people to rethink their relationship with pharmaceutical care. I want to help right the information imbalances I see, which result in confused patients and bamboozled physicians, the main targets of pharma’s incredible marketing muscle.

As a drug policy researcher, I am like a patient myself, but instead of drugs, I swallow large daily doses of evidence from studies, reports and analyses, many of which describe acts of deception and malfeasance that results in large numbers of people putting unnecessary pills into their mouths. And it makes me nauseous.

You might ask, “So why write, Alan? Why try to educate people? Isn’t it futile?” If I knew of a better way to bring more muscle to ordinary people who are naked and defenceless in the pharmaceutical marketplace, I’d do that. As a chronicler of what I see, I have learned that information in the hands of people – good information, which is unbiased and straightforward about their drugs and their health care – can help steer people in the right direction. It can get them asking questions and build their powers of ‘healthy skepticism.’

Selling Sickness documented pharma’s many tentacles reaching into the public sphere: from the shaping of medical research to the biasing of academic medicine and the ‘wining and dining’ of doctors, to the courting of patient lobbyists and the corrupting influence of media and advertising. That book emerged at a point when there was evidence of a shift in the public consciousness about the pharmaceutical industry and we soon found our book had some company on the shelf. Marcia Angell’s excellent The Truth about the Drug Companies, John Abramson’s Overdosed America and Jerry Avorn’s Powerful Medicines all spoke to the ranging power of this industry’s tentacles. Yet five years on, have things changed?

I would say yes, there have been changes, but the pace of change has been glacial. Despite a raft of lawsuits, real efforts to bring balance to clinical research and more public attention to their nefarious tactics, the pharmaceutical industry continues to influence the public, physicians and policymakers. Sadly, the tentacles of this empire continue to sell sickness through deception and fear, creating new markets for their products. The industry still spends billions per year marketing diseases and drugs, advertising through the power of television and the internet, inserting itself into medical decision-making bodies and bamboozling physicians by paying for their education.

And in some cases the outcomes are even worse than before. The prescribing of some of the world’s most toxic prescription drugs – antipsychotics, for example – is truly horrifying as those drugs are prescribed for the very young and the very old with abandon. As more and more mental health issues are labelled as troubling, the use of antipsychotics continues to be so far out of line with rationality as to be frightening.

The number of children and adolescents treated for bipolar disorder in the US rose 40-fold between 1994 and 2003, due mainly to the fact that makers of the most expensive – and most marketed antipsychotics (drugs like Seroquel or Zyprexa) – are funding the further labelling of kids. One study found that nearly 20 percent of kids who visited a psychiatrist walked away with an antipsychotic drug prescription. And all this despite the known, serious dangers of those drugs, especially when taken by children.

In BC, Common Ground’s home turf, there’s a sea of examples demonstrating the power of the pharmaceutical industry is as strong as ever. Two years ago, the BC government created a Pharmaceutical Task Force to examine the workings of the public drug plan. It staffed it with a variety of pharma’s lobbyists, including university and pharmaceutical company executives, people representing retail pharmacy and others who could be counted upon to deliver a report to serve the voracious appetite of the industry.

Among other things, the Task Force recommended dismantling the few bulwarks that exist in this province against the inappropriate marketing of disease and drugs. It put a bullet into the Therapeutics Initiative at UBC, one of the best organizations in the world providing unbiased assessments of the value of new drugs. The TI was a publicly financed body, essentially there to throw physicians, drowning in a sea of pharmaceutical spin, a lifeline. The government’s and UBC’s drug-addled response? Let’em sink.

The industry’s influence on patients in BC continues in the form of the Better Pharmacare Coalition, a rag-tag collection of disease groups that pretend to be the voice of ‘the people’ on drug policies. Lately, they’ve morphed into a mouthpiece for the wretched Task Force and its silly recommendations. As an aside, if you are a member of any of the BPC’s member organizations – the Arthritis Society, the Heart and Stroke Foundation and the MS Society, among others (check Google to find the full list) – you might want to ask yourself if you like your organization wearing woolly, sheep-like clothing for pharma’s wolves.

The industry continues to fund “disease awareness” campaigns that fly under the radar of our laws against direct-to-consumer advertising of pharmaceuticals. These campaigns sound public spirited and helpful, as they implore people to go out and get their cholesterol or their blood sugars checked and be screened for diseases of all sorts using the omnipresent punch line: “See your doctor.” Disease awareness campaigns that I have written often about in my “Drug Bust” columns have one key goal: to convince more and more of us to stop feeling healthy and start worrying. As the old saying goes, “If you feel healthy, it’s only because you haven’t had enough tests.”

And trust me, when the industry is begging you to “see your doctor,” it’s because one of their reps has already ‘seen’ your doctor and they’ve given her the kind of advice that results in a “drug successful visit.” (This is true pharma-salesmen lingo, by the way. They actually say this stuff.)

Ray and I may have been somewhat prophetic around disease mongering in the last chapter of Selling Sickness where we describe the ongoing campaign to get women to question their sexual health and to seek medical treatments for female sexual difficulties. In the rush to create the first version of “Pink Viagra,” the pharmaceutical industry and its research tentacle is earnestly telling women this ‘Big Lie:’ disinterest in sex is a disease and we will soon have something to relieve your ills. Ray Moynihan has co-authored a book with UBC epidemiologist Barbara Mintzes entitled Sex, Lies, & Pharmaceuticals. It is due for release in October and I will be discussing the phenomenon in my column that month.

Clearly, five years on, there is still a lot of work to do. So when people ask me, “Alan Cassels, what are you doing to counter disease-mongering and the undue influence of the drug industry on the public, physicians and policymakers?” my answer remains the same: “I keep writing and speaking.” There’s still a lot of slippery tentacles that need to be exposed to the light of day.

My loyal “Drug Bust” readers should know that, in a previous life, I was a navy diver and I have had the opportunity to wrestle with octopi in 50 feet of water. They’re wily creatures, but they can be outsmarted. The way it looks now, until the pharmaceutical industry puts a bullet in me, “Drug Bust” has a future.

Alan Cassels is a pharmaceutical policy researcher at the University of Victoria. October 16: Common Ground Special Events presents a talk and Q&A with Selling Sickness co-authors Ray Moynihan (author of the new book Sex, Lies & Pharmaceuticals) and Alan Cassels. Details TBA in our October issue. Read his other writings at