By Maryse IsmaSpecial to CSMS MagazineIn the light of recent revelations about the harmfulness of the prescription drug rofecoxib (Vioxx) and other painkillers, drug companies have come under increased scrutiny. Many saw it coming. Between 1997 and 2001, drug companies tripled the amount of money they spent on direct-to-consumer advertising for prescription drugs—the ads now seen so frequently on television and in newspapers. The number of retail prescription drugs rose from 2.4 million in 1997 to 3.1 million in 2001. Those prescriptions carry a total yearly price tag of at least $ 200 million, with the cost rising about 12% per year, approximately six times the rate of inflation. But doesn’t the increased use of medications signal better health for Americans? Not necessarily.            Many claim that the increased costs of drugs reflect large investment in research and development (R&D). The true is that drug companies spend more than twice as much on “marketing and administration” as they do on R&D—31% of sales, compared with 14% in 2003.            Drug industry sources say the R&D cost per drug is $800 million on average. An independent analysis by the nonprofit consumer advocacy organization Public Citizen shows that the real cost is probably $100 million or less.            Actually, the big drug companies don’t develop most of the novel medications. These drugs, such as the cancer medication paclitaxel (Taxol) and imatinib (Gleevec), mostly are the result of taxpayer-funded research at academic institutions or National Institutions of Health (NIH) or research at small biotechnology companies.            Are new drugs are constantly being brought to market really new? Let’s see. Of the 487 drugs approved by the FDA from 1998 through 2003, only 32% contained new active ingredients and fewer than half of those (14% of the total) were classified by the FDA as improvements over older drugs.            Most “new” drugs are chemical variations of older drugs already on the market—so-called “me-too” drugs. Companies try to grab a piece of a profitable market by producing a medication similar to a top-selling drug.            A good example is Mevacor. Approved in 1987, Mevacor was the first cholesterol-lowering statin in the marketplace. Now, there are five more, all variants of the original—Lipitor, Zocor, Pravachol, Lescol and Crestor. Even though Lipitor and Zocor are the top-selling statins, no head to head studies have been conducted comparing their effectiveness with lovastatin (the cheaper generic form of Mevacor) when taken at equivalent doses.            Are scientific studies on drugs are reliable? Let’s see the facts. Drug companies have always sponsored almost all research on their drugs, but now they control how the research is done and whether it will be published. Much of this research is seriously flawed, presenting results that cause both doctors and consumers to believe that drugs are a lot better than they are and have fewer side effect than they do. What’s more, only favorable results are published. Unflavored results rarely see the light of day.            There have also been many controversies surrounding doctors’ prescribing habits aren’t unduly influenced by drug companies. Again, let’s see the facts. In 2001, the drug industry employed approximately 88,000 sales representatives to visit doctors in their offices and hospitals to promote their products—roughly one representative for every six practicing physicians. Drug reps attend medical conferences and offer doctors expansive gifts, many do accept dinners, football tickets, family vacations, etc.            In 2001, drug companies paid more than 60% of the costs for continuing medical education for doctors. Meetings of professional societies, such as the American College of Cardiology and the American College of Physicians, now are largely sponsored by drug companies.            Knowing this, do you think the prescribing habits of doctors in America are based only on the objective evaluations of their patients?

How can one protect himself?

 To protect oneself against drug industry tactics, there are several tips I am recommending. These tips were taken from 100 Most Common Medical Blunders.

• Ignore drug ads. An ad is meant to sell something, not educate or inform. Drug ads are no different. There’s a good reason that direct-to-consumer drug ads are illegal in every other developed country (except New Zealand).
• Be skeptical about new drugs. When it comes to drugs, newer doesn’t necessarily mean better. There are exceptions, but you should make sure your doctor is relying on scientific evidence, not just a sales pitch from a drug company. 
• Watch out for “me-too” drugs. If a drug is being advertised on TV, it’s probably a me-too drug. The drug company is trying to convince doctors and patients—usually in the absence of any scientific evidence—that the “new” drug is better. 
• Always ask for an equivalent generic or over-the-counter (OTC) drug. Doctors tend to prescribe what the drug company reps who haunt their offices are pushing. There may be a cheaper alternative that’s just as effective. Ask about it. 
• Beware of free samples. Drugs reps give doctors free samples of expensive drugs. When the sample runs out, both doctor and patient are in the habit of using that particular drug. If you accept a free sample, be sure there is a compelling medical reason to take that drug. 
• Don’t be easily convinced that you have a new disease. Do you really need to take the me-too antidepressant paroxetine (Paxil) for “social anxiety disorder”—when you though you were just shy? 
• Give your doctor permission not to prescribe. Many doctors assume—correctly, in many cases—that a patient won’t feel satisfied unless he/she leaves the office with a prescription. 
• Tell your MD: If I don’t need a prescription drug, then don’t prescribe one.

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