Pharmalot: I'm wondering whether you were aghast at all of the marketing pitches and ploys back when you were still working at the Times. And if so, how'd that affect your view of the industry? Petersen: When I began covering the industry in early 2000, I believed the drug companies were all about science. But after following the industry and talking to executives, I saw that my early impression was wrong. For example, that year, some of the most talked-about drugs were products like Nexium, Advair, and Clarinex. The companies said these were “new” drugs. They weren’t. They were little more than old drugs, tweaked a little in the lab and then heavily promoted to make the public believe they were new. I realized that it wasn’t science that drove these companies. It was marketing.
Pharmalot: What do/did you say to people who complain the media is too critical of big pharma and harps on negatives - such as marketing gaffes or side effect reports - and overlooks the positive contributions made by research? Petersen: I know the pharmaceutical industry likes to blame the media for its problems. Unfortunately, the industry gives journalists a lot to write about. The industry sells products that can help people and save lives, but that hardly gives it the right to hurt other people through aggressive marketing.
Pharmalot: Now, to the book: You describe a system that, basically, ran amok and is rigged. How did we get to this point? Petersen: The simple answer comes down to the piles of cash the industry has to spend. Our medical system once had many safeguards to protect patients from drugs they didn’t need. Academics and universities once helped keep the industry’s clinical trials objective and honest. Physicians once were independent from the industry and acted as gatekeepers who put patients first. The FDA once did not require fees from the industry to fund its operations; it’s only client was the public. But all these groups are now dependent on the industry’s cash handouts and patients have suffered. The safeguards have disappeared. The drug companies have learned they can sell just about any pill by spending heavily on promotion. There are relatively few independent experts left who are willing to point out how the system has gone wildly wrong.
Pharmalot: Is there any going back? How can pharma survive without heavily relying on the marketing machine? Petersen: The industry needs to get back to the hard work of using science to discover genuinely new medicines that help the sick and ease suffering. In fact, it’s hard to see a need for companies that don’t do that.
Pharmalot: You suggest several changes in behavior and regulation, such as rolling back DTC advertising to pre-97 constraints. Basically, you're saying DTC hasn't worked. Isn't that like throwing the baby out with the bath water? Some people insist they're more aware of their health because of those ads. Petersen: The television ads have made people believe that all they have to do is swallow a pill and life will be grand. They’ve warped the public’s view about health. I have a lot of gripes with the ads. That said, I actually think the ads are less damaging than all the other promotion the industry does from behind the scenes. I’m talking about the promotion that is disguised to look like its coming from an independent source. Things like the hiring of celebrities and doctors to talk up the benefits of drugs and the creation of medical journal articles that have been ghostwritten by marketers. That is the stuff that is especially dangerous because people don’t have their guard up like they do with advertising. I wrote the book because I wanted people to be able to see through this covert promotion.
Pharmalot: Another suggestion involves requiring docs to provide patients with lists of their interactions with, and ties to, drugmakers. Why is that realistic? Petersen: I actually want a law that bans companies from giving cash or gifts to physicians, while also making it illegal for physicians to take anything from the industry. That’s what we really need. At a minimum, doctors should be required to keep track of everything they receive from the industry and give this list to every patient checking in with the receptionist. By law, political candidates must keep track of all donations and gifts. If doctors want to take corporate handouts, they should have to do the same type of recordkeeping and disclose the list to their patients.
Pharmalot: Do you see any differences now in big pharma's collective behavior than you did while researching the book? If so, how? Petersen: You’re kidding, right? If anything, the marketing has become more aggressive as some of the industry’s big-selling blockbuster drugs have lost their patent protection.
Pharmalot: Drugmakers have a new mantra - transparency - such as posting clinical trials. In your view, is this for real or is it just talk? Petersen: Last year, President Bush signed a law aimed at increasing penalties for companies that don’t quickly disclose clinical data. I hope that will help. But even if the companies now began disclosing all information, we will never learn about the results of an untold number of older clinical studies that have never been published even though they involve drugs still being prescribed.
Pharmalot: Of the various anecdotes about people you wrote about in your book, which moved you the most, and why? Petersen: All the stories in my book about patients who died or were hurt by prescription drugs are heartbreaking. Pharmalot: Which anecdote involving a drugmaker angered you the most, and why? Petersen: It’s hard not to be angry about any case where aggressive marketing harms patients and takes lives. I write about so many of these needless tragedies. It’s impossible to say that one of these cases was somehow more or less egregious than another.