When I travelled to cities outside the United States, I routinely wandered the streets without any destination in mind. This gave me a feel for the city away from the landmarks and tourist attractions. On one such excursion in London, England, I came across an advertisement painted on the side of a crumbling brick apartment building. The top left corner of the ad had been obliterated by weathering of the paint. It apparently had the name and logo of a medication.
Still legible on the relatively intact side of the building was a claim that this drug, ointment, elixir, or potion eliminated the signs and symptoms of innumerable diseases. Rheumatoid arthritis, syphilis, gout, gonorrhea, dropsy (never mind what that was), psoriasis, and balding were all specifically mentioned as responding to this wonderful stuff. I thought what a tragedy that we lost track of this marvelous concoction. Given the age of the building and the condition of the advertisement, I estimated that the ad had been painted in the 1940s. The claims made in the ad were not surprising. Similar claims had been made for secret brews and powders for more than a thousand years.
What is also not surprising is that outrageous, misleading, or erroneous claims are still made in drug and medical device advertising in all manner of media. Over the course of two hours of evening programs, I was reminded that drug manufacturers had found the cure for hepatitis B, had several, highly effective treatments for multiple sclerosis, could extend your life by several decades with anti-HIV medications (if you had the virus), could improve your penile performance with any one of several pills, could free you from your intractable depression, could reduce those annoying migraine headaches and rid you of those ugly facial wrinkles, and could protect you from an unwanted pregnancy with the assistance of a plastic and copper intra-uterine device (IUD). There were, of course, risks that were associated with all of these wondrous innovations, but they were mercifully listed in a subdued and monotonous voice while you observed people celebrating their good fortune and formidable health.
To get these modern miracles, you need to convince a doctor that he or she should write a prescription for you. That is usually not very challenging, since the doctor has probably heard about the advertised drug or device from sales people, called “detail men and women.” These drug company representatives are usually young, engaging, energetic men and women, often equipped with free samples and routinely offering free meals. In the 1970s and 1980s they also regularly supplied physicians hungry for more information about the drugs they were selling with trips to the Caribbean and golf outings. The Food and Drug Administration placed some restrictions on these “educational” junkets, but ever creative drug companies found numerous alternative mechanisms to get the attention and loyalty of physicians. The cost of this generosity was (and is) passed on to the consumers.
The marketing of drugs and medical devices has become so effective that it is rare to find a person over the age of 21 not taking advantage of at least one health-promoting or health-enhancing item. Unfortunately, many people are getting too much of a good thing. For example, antibiotic development since the 1950s has reduced the suffering and extended the lives of many millions of people, but the indiscriminate use of these drugs has resulted in the development of highly resistant strains of bacteria. Advances in pain killers have been a mixed blessing with a large part of the population facing the consequences of the opioid crisis. The aggressive prescribing of multiple drugs for the same problem, a practice referred to as “polypharmacy” and routinely promoted at drug workshops, increases the risk of dangerous drug interactions.
Another legitimate concern in the provision of healthcare is the cost of providing effective care for all. Part of the cost of care is the cost of drugs and devices. The first treatment for multiple sclerosis (MS) introduced in the 1990s cost $15,000/year for a routine course of treatment that would continue for decades. The prices for competing MS drugs subsequently developed have generally been higher than this at launch. Multiply these costs by the dozens of new drugs introduced each year, and the cost obviously becomes prohibitive.
Industry claims that the prices they charge for new drugs and devices are needed to support ongoing research and development are often false. Marketing costs may be disguised as research and development costs. Expenses incurred by several companies involved in drug and device development may be described by the company that markets the drug or device as part of their cost, even though the final entity selling the drug or device may have spent little of its own money on getting a drug to market. Drug companies routinely pay “competitors” to keep their generic equivalent drugs off the market, thereby allowing the brand name manufacturer to reap inflated profits for several years after their patents expire.
Many industrialized countries have found ways to manage excessive healthcare costs, but the U.S. has failed to embrace successful methods for cost containment adopted elsewhere. This is unfortunate and burdens all of us with unnecessarily inflated costs. The usual justification for this laissez faire approach in America is that the government should not interfere with the free market, but the idea of the “free market” in connection with drugs and medical devices is a myth that needs to be retired. Demand for drugs is routinely being manipulated by exaggerated claims of efficacy and aggressive marketing campaigns. Pricing has little or no connection to development and distribution costs. To move toward affordable healthcare, we need to get rid of, or at least get better control of, the drug and medical device manufacturers and marketers that are reaping obscene profits at the expense of our well-being.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.