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Big Pharma


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The moniker as the pharmaceutical industry is widely known, is testament to the immense power held by the handful of firms that research, supply and manufacture the vast majority of drugs consumed on a regular basis. With global revenues in excess of US$1.4 trillion, the industry rakes in unprecedented sums each year, primarily attributed to the sales of routine prescription drugs and medical devices.

Council on Foreign Relations, Brad Setser
While Big Pharma has greatly enhanced our quality of living through the invention of numerous treatments and even vaccines for preventable illnesses, criticism of the industry is at an all-time high. Despite earning billions annually, top pharmaceutical firms have simultaneously spent billions on settlements with the Food and Drug Administration (FDA) and class action lawsuits from aggrieved patients. Time and time again, business ethics have been brushed aside in favor of record profits. Misleading marketing, false claims, conspiracy to defraud — The list goes on with various Big Pharma firms forced to settle with court juries or pull their products from the market. Perhaps it is unsurprising that Big Pharma has repeatedly ranked among the most hated industries in the US in opinion polls across consecutive years.
OxyContin, the catalyst of the opioid epidemic. Image Credit: Reuters
GUILTY as charged: On the legal side of things, an impasse between the attorneys general of several US states and (represented by its owners, the Sackler family) appears to be resolved with the Sacklers committing up to US$6b to settle ongoing litigation concerning its role in fuelling America’s deadly opioid epidemic, a tiny step in the direction of closure for the millions who have lost their loved ones. At the heart of this decades-long crisis is oxycodone, a potent opioid and controlled drug prescribed for chronic pain relief (distributed under brand name OxyContin since 1996). In the worst ever public health tragedy, Purdue spent aggressively on promoting the drug following its release, lavishing spending on distributors of OxyContin. By 2000, annual sales surged past the billion-dollar mark, bringing unrivaled profits from a single drug. However, Purdue fell silent when it came to the diversion of OxyContin to a growing opioid addiction.

YET, THIS IS JUST THE TIP OF THE ICEBERG: Purdue Pharma is not the only company to have promoted prescription drugs for profit over health. Prescription drug abuse has been rampant across America for decades, but the problem has significantly worsened in recent years. Let’s examine some statistics: 18 million people aged 12 and older, corresponding to nearly 6% of the US population, have used prescription drugs for non-related medical reasons in the past year. But this wasn’t always the case. Let’s look at the drivers behind this rise in abuse.

ONE key driving factor in the increase in prescription drug abuse is the fall in consumer out-of-pocket expenditure. From 1990 to 2020, consumers’ share of spending on drugs dropped from 57% to 15%, with increased shares of spending covered by Medicare and Medicaid, a result of reinforcement by the Bipartisan Budget Act of 2018. Recent government spending on healthcare can thus be said to have unintended consequences for the very people they were meant to benefit.

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Another important reason is that increased access to generic drugs (those whose private patents have expired) also explains the rise in use of prescription drugs. From 2009 to 2018, the share of prescriptions for generic drugs more than doubled, largely benefitting low and middle-class families who are better able to afford drugs. This, however, is a double-edged sword. Abuse of these drugs is more likely to occur in these families, who lack medical knowledge yet do not possess enough financial resources to visit the doctor everytime illness strikes, choosing to pop a pill instead.

BUT WHAT’S THE FUSS ABOUT DRUG ABUSE?

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Of course, such casual and repeated drug usage has its fatal downsides. It changes how our brain works, creating a vicious cycle of addiction fueled by the brain’s desire to feel pleasure. The most common case of drug abuse, the Opioid epidemic, was caused by human’s dependence on opioids as pain-killers, growing accustomed to the high and pleasure caused by such consumption. Illegally snorting or injecting opioids increases chances of overdose, resulting in breathing problems, or even death. Prescription drug abuse is just like any other addiction, so this begs the question. Why isn’t it given more attention and media coverage?

Unsurprisingly, a big part of it is profit. The more pharmacies can sell, the more cash they can rake in. Naturally, what better way is there than to place them directly within these consumers’ reach – without the need for any physician or pharmacist, but simply a grocery transaction?

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Now that the pharmaceutical companies have created an alarmed public, what’s left to do is to sell their treatment products. Enter the world of over-the-counter (OTC) drugs – drugs that can be obtained without any form of consultation with a professional (unless you count the usual online Big Pharma ads, of course). Despite their comprehensive virtue-signalling with the repetitive, memorable labels warning against the risks of self-diagnosis, they are simultaneously begging for self-misdiagnosis by seeking to make drugs for anything and everything easily attainable.


Image Credit: BeMedWise
You see, the ubiquitous advocacy that repeats the lines of “consult a medical professional” or “seek advice if unsure of suitability” are simply there to fulfil legal obligations, that uphold high standards. In 2015, the U.S. Food & Drug Administration (FDA) issued the Drug Facts label, which mandates OTC drugs to clearly display, when necessary, the need to consult trained medical professionals. Not wanting to risk crossing any line, almost every drug today has that label prominently exhibited.

These drug companies’ true intentions are not as simple. The market for OTC drugs has been steadily expanding, as the industry saw markedly heightened profitability. Not only do OTC drugs provide more brand awareness for the firms, their convenience involved has made them the preferred treatment mode for 93% of Americans.

So, what actions has Big Pharma taken to promote OTC adoption?

Poster by Pfizer, 2014
On the consumers’ end, pharmaceutical companies have gone through meticulous marketing through their aforementioned generous budget assignments. For example, drug production industry leader Pfizer, which has no role in objectively educating consumers on what modes of medication they should obtain, and whereby any of such information is to clearly fulfil marketing needs, published a poster in 2014, actively ameliorating OTC medicines.

When the CEO describes OTC drugs as “an important harbinger of where the market is going” to a call with analysts merely one year prior, the point that such promotion of OTC drugs are simply to serve a marketing purpose is enhanced.

Over in Germany, pharmaceutical companies were recorded to have pushed for various OTC vaccines for bacterial pyelonephritis, scientific for a kidney infection, in 2014. Caused essentially by an Escherichia coli (e. coli) infection, the disease has had no vaccines approved by the Centers for Disease Control and Prevention (CDC) as of July 2019. This means that when the OTC applications were filed by the pharmaceutical companies, related vaccine development technology was so premature that none of such of acceptable effectiveness would even be ready five years later. The question is begged: if the vaccine was to be approved, what would happen to these consumers? And more importantly, were these applicants truly unaware of the inadequacies in their products, and if so, what were their true intentions?

On top of that, the disease in question is a kidney infection. A serious condition that, not only can be easily confused with a urinary tract infection (UTI), but also may lead to kidney scarring or septic shocks, kidney infections do require medical attention. For that pharmaceutical firm to encourage the public to self-diagnose something like this and then inject themselves with its vaccine is simply ridiculous, if one is unaware of their profit-seeking intentions.

A deeper dig reveals more. In AstraZeneca’s 2010 approval application of their new drug Brilinta, the pattern of later-pay conflicts of interest could be seen. The panel in question, responsible for making the decision, contained four physicians. After a 7-1 passage of the drug, AstraZeneca was found having funded one of the physicians, Jonathan Halperin, over $200,000 from 2013 to 2016.

The later-pay conflict of interest phenomenon is rather widespread, and an analysis of similar cases found these details:


Perhaps on a larger scale, Big Pharma has attained notable political influence over the FDA. The authorization body over all of its products, the FDA is granted its budget and has its decisions overseen by Congress. With an eye for such detail, Big Pharma has seized the opportunity to infiltrate the integrity of Congressmen. The multi-billion industry has contributed $1.6 million in donations simply within the first six months of 2021, and from 2016 to 2019, lobbying group Pharmaceutical Research and Manufacturers of America (PhRMA) alone has donated at least $10 million to the right-wing lobbying group American Action Network. As the sitting President comes from the right wing, and has executive oversight on FDA decisions. No coincidence.

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As an industry that is directly involved with our human health, ethical checks and balances for Big Pharma is especially paramount. While an overwhelming vertical reach along the value chain may allow for efficiency, through the sharing of technologies and an expedited implementation process, appropriate distancing is equally, if not even more paramount. Conflicts of interest must be avoided at all costs, as a compromised quality enforcement process will lead to detrimental health effects on the human race.

 

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