Just weeks before the first COVID-19 cases emerged, Gallup published its latest poll on citizen views about business. At the bottom of the list of 25 sectors was the pharmaceutical industry.

Below advertising. Below oil and gas. Below the banks.

Or how the industry got so big. One company, Johnson & Johnson, is currently worth around US$450 billion. About the same as the economy of Norway.

Yet, despite ranking so low prior to the pandemic, many seem to think that these groups have suddenly switched to become ‘noble heroes’ that are now serving to protect us.

These groups are attempting to re-engineer their public reputation during a time of ‘crisis’ — but let’s not forget why the pharmaceutical industry’s credibility sank so low in the first place.

THE RISE TO CONTROL

To set the stage, we must trace back the rise of Big Pharma.

The idea of a ‘miraculous potion’ or ‘cure’ dates back as far as the dawn of alchemy, and perhaps the even in the mythos before that. The goddess Panacea gets a mention in the Hippocratic Oath.

The rise of the modern pharmaceutical industry is more recent, coming through the 19th century. Still, besides oil, medicine was one of the early behemoths to emerge during this period.

On the eve of the 20th century, the German company Bayer famously launched its early blockbusters, including ‘Aspirin’ and ‘Heroin’. Synthesising nature for mass consumption.

Around this time, drug-makers began arguing for patent protections or exclusive rights to market a drug for a specific period of time. By the 1950s, they’d won those arguments, and the US soon became the world’s biggest market for medicines.

Coupled with the rise of laboratories, monopolies began to form and profit began to swell.

In addition to patents, the other special ingredient for success included the right to market pills directly to doctors, and in the US, directly to consumers via television commercials.

It is hard to image today, but medicines and doctors dominated the public sphere. We are familiar with ‘health professionals’ once advertising for cigarettes, but it goes far deeper and more frequent.

It was not long before Big Pharma began to have immense growth with this exposure.

At the dawn of the 21st century, in the days before Facebook and Big Tech would burst on to the scene, pharmaceuticals were among the most profitable industries on the planet.

EXTORTION, TAX EVASION

Clearly, many medicines extend lives and reduce suffering. Antibiotics revolutionised the treatment of deadly infections, and gave a boost to science at the same time.

Yet, in each case, the golden drugs always have a dark side that follows them.

As the World Health Organization notes, overuse of antibiotics helped make antibiotic-resistance “one of the biggest threats to global health”.

Over-pricing and patent protections for HIV medicines put them out of reach of the world’s poorest, and prices only came down after massive global campaigns for greater access.

With cancer, companies demanded huge prices for products offering minimal benefits. Extortionate prices were feeding drug company mega-profits, while driving down industry reputation.

In a notorious example, the cost of the life-saving Epipen skyrocketed more than 400%, helping make drug prices a big issue in the 2016 US presidential election.

Industry argues ‘high prices fund vital research’. Critics say companies can spend more on marketing than research, and their profits sometimes derive from taxpayer-funded science.

To make matters worse, the big pharmaceutical companies are also among the big tax avoiders. A 2015 Senate hearing in Australia heard companies were paying rates as low as one cent in the dollar.

A global report from Oxfam in 2018 concluded the pharmaceutical industry was “cheating countries out of billions in tax revenues”.

INFLUENCE OVER SCIENCE

The major problem with drug giants is their unhealthy influence over medical science.

The industry dominates research, and there’s strong evidence that company-sponsored studies tend to have a bias which favours the sponsor’s product.

Medical education is also heavily sponsored, with evidence suggesting an association between a doctor accepting just one meal at an ‘educational event’, and prescribing more sponsored drugs.

In addition, many guidelines which can be so influential over a doctor’s prescribing decisions are too often written by medical experts with ties to drug companies.

Central to this marketing effort are ‘senior medical experts’, also known as “key opinion leaders”, who claim to be ‘independent’, yet accept fees for advice, consultancies or ‘educational’ presentations to other doctors.

A former top-selling drug company sales representative, now turned whistleblower, put it plainly in a 2008 piece in The BMJ:

“Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations.

If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.”

This type of collusion means the latest, most expensive pill, is too-often favoured over cheaper options, or does nothing at all, causing much harm and wasting precious resources.

CORPORATE CRIME

In 2009, came the biggest health-care fraud settlement in history.

Pfizer — current manufacturer of a leading COVID-19 vaccine — was forced to fork out a US$2.3 billion fine for illegal promotion, false and misleading claims about drug safety, and paying kickbacks to doctors. That included a US$1.2 billion criminal fine, the largest in U.S. history.

One of the whistleblowers in that case happened to be a member of a special Pfizer sales team promoting Viagra. He revealed doctors were taken to breakfasts, lunches, dinners, Broadway shows, baseball games, golf courses, ski fields, casinos and strip clubs.

In 2013, Johnson & Johnson paid out US$2.2 billion in civil and criminal fines for putting “profit over patients’ health”. The company illegally promoted powerful anti-psychotic drugs as ‘behaviour control’ for the elderly and vulnerable.

They overstated benefits and playing down dangerous side effects, including stroke.

Other court documents around the same time exposed how the giant global company Merck used dirty tricks to try and defend its controversial anti-arthritis drug Vioxx. Merck created a fake medical journal and drew up secret lists of academic critics to “neutralise” and “discredit”.

In the end, Vioxx was taken off the market because it was causing heart attacks, with estimates in The Lancet suggesting it may have led to 140,000 cases of serious coronary heart disease.

INVESTIGATIONS AND REFORMS

Big Pharma wonders why people are so suspicious of their COVID-19 activities? Even though they have routinely tarnished their own industry’s image and brought more intense scrutiny.

For example..

The US National Academy of Sciences produced a landmark report arguing the closeness between doctors and drug companies could jeopardise the integrity of science, the objectivity of education, the quality of care, and public trust in medicine.

Italy brought in a special tax on drug company promotion to fund public interest research. Norway doesn’t give doctors full credit anymore for industry-sponsored education.

A series of US congressional hearings on unhealthy marketing produced the Open Payments register, mandated by U.S. law, to publicly list every company payment to every doctor.

However, many companies across the world are now attempting to avoid this, moving from transparency to ‘independence’ or ‘philanthropy’. It is a constant battle to regulate Pharma.

And there’s a long way to go. A recent study in 2020 found 80% of the medicos who run the world’s most powerful doctors organisations still take money from drug and device companies.

For research, for consultancies, for hospitality.

Even some agencies which assess drugs, notably the US Food and Drug Administration (FDA), still rely on significant funding from industry, which pays to have its products assessed.

Thus the harmful marketing has continued, and continues to this day.

Just last month, a group of drug companies, including Johnson & Johnson, agreed to pay a total of US$26 billion for their roles in fuelling the opioid epidemic.

I wonder why people are suspicious about your vaccines? Hmm.

One drug company chief reportedly said last year the industry had a “once-in-a-generation opportunity to reset” its reputation.

However, the people will never forget the pain and suffering your ‘mistakes’ have caused.

Given the dark arts that drove Pharma’s credibility to rock bottom, its fanciful to imagine the pandemic will magically end the extortion, misleading messages and doctor influence.

Free thinkers are justified to question an industry of known liars.

For more detailed information on the influence of Big Pharma in Australia, check out our previous feature presentation on the subject below!

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