The great health grab: the world's giant drug companies pursue profit above all else. Dinyar Godrej inspects an industry that's more than a little sick - Big Pharma / Keynote

If innovation isn't the industry's forte, adapting research to the profit motive certainly is. The top drug companies tend to keep management and marketing divisions well away from the researchers, who may get carried away by the mere health benefits of a new drug. It is management's job to spot the blockbusters (drugs with potential sales of a billion dollars or more) and ruthlessly press for their development--often axing significant discoveries that don't have the same selling power. Once a blockbuster is identified, research must be swift and show the best possible results. Industry critics argue that trials are manipulated with these aims in mind and negative results actively suppressed. Part of the fallout from this is a 'dosing regime' based on what was shown to work fastest in trials. This means that often when a drug comes to market a single dose is specified for all patients from 18 to 80--regardless of individual sensitivities. Doctors follow the drug company's dosing regimen and an epidemic of side-effects follows. According to Jay S Cohen, a doctor who has been campaigning for more 'tailored' doses: 'Medication reactions are the fourth leading cause of death in the US, dwarfing the number of deaths caused by automobile accidents, HIV/AIDS, alcohol and drug abuse, infectious diseases, diabetes and murder.' (11)

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Once a new drug hits the market, a buzz is created through glitzy advertising (in the US and New Zealand/Aotearoa companies can pitch prescription drugs direct to the consumer) and favourable reports in professional journals. Drummond Rennie, a deputy editor of the Journal of the American Medical Association, suggests how such reports come to be written:

'I'm the advertising guy for the drug. I tell a journal I will give them $100,000 to have a special issue on that drug. Plus I'll give the journal so much per reprint and I'll order a lot of reprints. I'll select the editor and all the authors. I phone everyone who has written good things about that drug. I say, "I'll fly you and your wife first class to New Orleans for a symposium. I'll put your paper in the special issue of the journal and you'll have an extra publication for your CV." Then I'll put a reprint of that symposium on some doctor's desk and say, "Look at this marvellous drug."' (12)

But patents are the icing on the cake, giving the drug biz exclusive control over a medication no matter how essential it is. Companies are keen on global pricing and keeping prices high. They will rush to punish patent violators with all the legal might at their disposal. Both Washington and European governments jump in to protect drug-company profits, threatening trade sanctions if violators don't comply.

Why bother squashing minor-league competitors in the Majority World when sales there are such a small slice of the pie and the industry earns obscene profits anyway? Maybe it's because Western consumers paying inflated prices may just realize they are being duped--and start demanding cheaper drugs.