Some drug companies put the pills before the patients

Published on
April 2, 2009

Six of the world's biggest drug companies are about to be winnowed down to three. If all the mergers go through, we will have Pfizer-Wyeth, Merck-Schering-Plough and Roche-Genentech controlling more than $100 billion in drug sales every year - amounting to one seventh of all revenues for drug companies worldwide. (I wrote a story about this a couple weeks ago for the Los Angeles Times.)

That is a pretty serious concentration of power. And it offers an opportunity for reporters to ask tough questions about the possible effects. What will happen to drug prices as a result? Will this consolidation eliminate some much needed competition in certain sectors of the market? Are we losing, or gaining, important research work in cancer, AIDS, influenza and other illnesses?

Seattle Times reporters Susan Kelleher and Duff Wilson asked some very tough questions in 2005 in a jaw-dropping series of stories about how the pharmaceutical industry had created and expanded diagnostic categories, making otherwise healthy people "suddenly sick." They focused on five main areas, hypertension, obesity, osteoporosis, deep-vein thrombosis and sexual dysfunction.

In the four years since the series was published, the drug companies have continued the trend. You need only glance up at a billboard while driving or check out one of the advertisements in your favorite magazine or newspaper to see how companies are coaxing people into the idea that they are sick. Have you watched one of those sleep medication ads and wondered why you can't have nice Abraham Lincoln dreams instead of having to try to name all the rest of the presidents just to lull yourself to sleep? Have you watched that cartoon water balloon bouncing across the screen and felt like bolting to the loo?

This is how great marketing works.

Ask the FDA press office for a table that gives you all the drugs approved for the period you want. Why not all of 2008? Then you can check how many drugs were attempts to address a problem that previously had not been medicalized.

Also check the FDA site. The great thing about the FDA is that they provide quite a bit of information on the Web. The terrible thing is that it can be onerous to find.

You can read about every drug approved by the FDA in recent years and the actual documents that back up the approval here, pulling up a detailed and hyperlinked list for each month. The vast majority of drug approvals are generic versions of already established drugs. If you just select New Drug Approvals, or NDAs, which make up about 120 approvals a year, you will see there are very few each month. If you look at January 2008, you will see an AIDS treatment, a drug that calms the stomach after chemotherapy and a blood pressure medication. You will also see that three out of the eight drugs are some sort of allergy/asthma medication: Alvesco, Flo-Pred and Xyzal.

This is an area right in line with the kind of work Wilson and Kelleher did. Someone with a stuffy nose or the occasional trouble breathing might have been told to drink some tea, take a hot bath, maybe put on some Vicks in the past. Now, there are more drugs than ever for allergies and asthma and more people than ever being diagnosed with these disorders. Are the treatments driving the diagnoses?