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review: non-fiction

David Healy

The bond between healer and patient is born of common purpose with a strong dose of faith. Buttressed by modern medical science, both share the belief that medicine does more good than harm.

That faith, plus savvy marketing, has turned the pharmaceutical industry into a recession-proof juggernaut earning more than $900-billion (U.S.) annually worldwide. However, what we get for an increasingly expensive pallet of pills are dubious benefits plus side effects that may be worse than the diseases they were developed to fight.

How we got here is the subject of Pharmageddon, the latest book by David Healy, a psychiatrist at Cardiff University School of Medicine in Wales, and one of pharma's most articulate critics. "Pharmageddon" refers to the ability of modern medicine to help individual patients while threatening the entire health-care system.

Following the Second World War, lawmakers around the world gave the drug industry increased patent protection for its products. That, plus making pharmaceuticals available by prescription only, gave drug companies near-monopolies on their products, setting the stage for blockbuster drugs like the cholesterol-lowering drug Lipitor and the antidepressant Prozac.

This is familiar territory for Healy. His long-held view that SSRI antidepressants such as Prozac and others increase the risk of suicide famously cost Healy a job as clinical director of the Mood and Anxiety Disorders Program at Toronto's Centre for Addiction and Mental Health back in 2000.

Patents were supposed to be given out for new drugs that provided a clear public benefit. Instead, Healy says, now it's only about the patent and the resulting opportunity to create a new blockbuster.

Healy cites a number of egregious examples. Zyprexa is an antipsychotic drug that was supposed to be more effective than other available drugs, with fewer side effects. To make the drug commercially viable, its maker, Eli Lilly, needed a new patent, which meant demonstrating some novel benefit not found with other antipsychotics. Healy says the company got it by citing a study of dogs that pitted Zyprexa against another drug that was never even marketed.

Healy says there was no basis to conclude Zyprexa was any more effective than other products on the market; quite the opposite. He says Eli Lilly has settled over $2-billion worth of claims that Zyprexa raises cholesterol and causes diabetes. But he adds that Zyprexa continues to earn Lilly billions per year.

Making drugs available by prescription only made doctors the key targets of industry marketing efforts. Healy shows the critical role branding played in the development of blockbuster drugs such as the top-selling anti-ulcer drug Zantac, the marketing of which to doctors was buttressed by everything from free pens to cash to attending medical conferences.

Healy argues convincingly that doctors are as vulnerable to product branding as everyone else, offering reassurance against a background of clinical complexity. He could have written an entire book on this alone.

Modern physicians believe good medicine comes from evidence produced by clinical trials that pit budding blockbuster drugs against placebos. But Healy argues that much of the evidence found in "evidence-based medicine" comes from clinical trials paid for by drug companies that are designed to show small yet statistically significant benefits of their medicines without demonstrating whether they actually benefit patients.

Like other critics, Healy recites the usual pharma bêtes noirs, from drug companies hiring scribes to ghostwrite papers on behalf of famous researchers, to suppressing studies that don't flatter their products. What's novel is that Healy says these criticisms – while true – are beside the point. He says pharma is quite happy to let critics raise these issues since doing so doesn't change the system.

Less convincing is Healy's argument that the distorted marketplace for patented pharmaceutical drugs is the main reason why there is no universal health care in the United States. That argument doesn't wash in Canada.

Healy proposes, then tears down, possible solutions. Ending patent protection would only threaten the drug companies now dependent on blockbusters for their very survival. He suggests ending the system of drugs by prescription only, but only as a "thought experiment."

Healy's call to regulators to return the system to its original purpose – the benefit and protection of the public – seems hollow. His book suggests Healy believes modern health care is on a slow boat to hell. And he doesn't know how to stop it, much less turn it around.

Brian Goldman is an ER physician in Toronto and the host of CBC Radio One's White Coat, Black Art, which focuses on the culture of modern medicine. He is also an expert on pain management and prescription drug abuse. He has used his own experience with the marketing of controversial painkiller OxyContin to argue that the relationship between pharma and physicians needs to be re-examined.

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