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Dr. John Abramson is an expert witness on the Canwest charter challenge case in favor of Direct to consumer advertising of prescription drugs (DTCA). He teaches medicine at Harvard. He wrote a book entitled “Overdosed America: The broken promise of American medicine”. His book explains how drug companies and private insurance have taken over the US Health Care system since the massive cuts in public funding of the Reagan period, and how that situation undermines patient care as well as medical research.

He gave a presentation at Hart House Theatre, University of Toronto, on March 4 entitled: “Drug ads: Is corporate free speech more important than your health?” The event was organized by Women and Health Protection, an advocacy group concerned with over-medication of women, and part of a vast coalition against DTCA which includes CUPE.

The Academic-Industrial complex

The US system of DTCA is not about freedom of speech but about corporations using our money to mislead us and increase their sales. In fact, the US has the worse ratio of healthy life expectancy to medical expanses in all OECD countries. In the US, there are seven times more invasive heart surgeries than in most other industrialized countries. Use of medication claiming to prevent heart disease is also much higher. But the long term health of people who have suffered from heart disease is no better than elsewhere.

But the real causes of the much higher level of heart disease in the US is not lack of medication or surgery (which they resort to many times more than other OECD countries) but the presence of risk factors (diet, lifestyle, smoking, etc.). Prevention is the best medical option, not drugs.

Since the 1980s (Reagan presidency), medical knowledge has been transformed from a Public Good into a Commodity. Reagan massively reduced funding for independent medical research and mediation trials, forcing researchers to look for pharmaceutical companies for subsidies. This has undermined the whole system, including the medical journals, who are more likely to publish studies with favorable conclusions about new drugs and treatments than skeptical or critical ones.

There has also been a movement, more recent, away from university-based trials to private laboratories. In 1991, 80% of clinical trials were still taking place in a university environment (with significant private funding but some academic oversight). In 2000, only 34% were in universities. This means drug companies can now design the trials in order to reach positive conclusions. For example they give larger doses of a new drug than of the previous one and then claim the new drug is more potent. They also block access too much of the data, claiming that it would infringe on their right to commercial secrets in a competitive environment. This makes peer review of that research close to impossible.

A study has demonstrated that these clinical trials are 5.3 times more likely to conclude that the product tested is a treatment of choice. Publicly funded trials of the same drugs usually reach different conclusions.

Three examples

For example, the New England Journal of Medicine published an article claiming that Vioxx was “safer” than its predecessors, when there was no proof of such a thing. The only difference between Vioxx and its generic equivalent is that it is much more expensive. The campaign for Vioxx earned its makers $2B a year, but at the price of 6000 deaths a year.

Another case is NEXIUM, a gastro-intestinal drug, which is no better than its predecessor and in fact almost the same molecule. Astra Zeneca spent $500M in DTCA during the first two years of existence of this drug and had sales of $1,95B in 2003 alone. NEXIUM costs $170/month for each consumer while its generic equivalent would cost $22/month.

Doctors are being trained to believe that what is written in medical journals is true and reliable information. This is contradicted by the case of the most recent generation of anti-depressants.

Half of the studies conducted on them were inconclusive as to their effectiveness. But most of those studies were not published or were altered by the journal editors. Studies with positive conclusions are 12% more likely to be published than those with neutral or negative conclusions. The fact is that those antidepressants are only effective for people suffering from deep depression, or 3% of those using them. For the other 97%, they have no more impact than placebos. (This based on a study of users of the drug in the UK.)

Don’t let DTCA into Canada

Researcher Elliott S. Fisher has estimated that $700B a year is overspent by the US Health Care system, or more than the entire Defense budget. This can be explained largely by the fact that in the US system, the government is prohibited from negotiating with the drug companies for price. Then that cost is covered largely by private insurance companies who have to charge prohibitive premiums to do so.

According to Dr Abramson, if we open the door to DTCA in Canada, it will corrupt our entire health care system and our political system. In the US, many congress people are working hand in hand with the drug companies, often finding very good jobs with those companies when they leave office. This inevitably undermines the Health Care system as a contribution to the Public Good and turns it into a profit making enterprise.