The Pharmaceutical Drug Racket- Part One

The Pharmaceutical Drug Racket - Part One

THE ROCKETING COST OF HEALTH CARE

"Medical 'ignorance' is costing us billions" reads a heading in the Daily Telegraph Mirror of February 24, 1991, over an article:

"Poor funding and a lack of knowledge about preventive medicine has led to a $2 billion blow-out in public health spending, experts say.

"These costs rose nationally from $26 billion to $28 billion [in one year] - an average of $1700 per person - according to figures to be released by the Australian Institute of Health."

Writing in an article in the Sunday Telegraph on October 27, 1991, the Federal Minister for Community Services and Health, Brian Howe, expresses his concern:

"Health care costs a huge amount of money: $1796 for every man, woman and child....

"The trouble is that if Medicare becomes too costly, this country can't afford to keep footing the bill: which means that individual Australians will have to foot the bill instead or go without the necessary health care.

"I believe the Federal Government should continue to pay much of the health care cost, but my concern has been that one day the Government will have to say it can no longer afford Medicare.

"Medicare is getting increasingly costly. Total government expenditure on Medicare benefits rose by 70 per cent between 1984-85 and 1989-90, and by another 11.2 per cent in 1990-91.

"Before the changes in the Budget were announced, Medicare benefits were expected to rise by another 28 per cent in real terms over the three years to 1994-95: that's approximately $1.3 billion...." (1)

The rocketing cost of health care in Australia is not unique to this country, but is typical of all industrial nations. In his book Limits to Medicine (1979), prominent medical historian, Ivan Illich, writes:

"During the past twenty years, while the price index in the United States has risen by about 74 per cent, the cost of medical care has escalated by 330 per cent. Between 1950 and 1971 public expenditure for health insurance increased tenfold, private insurance benefits increased eightfold, [2a] and direct out-of-pocket payments about threefold. [2b] In overall expenditures other countries such as France [2c] and Germany [2d] kept abreast of the United States. In all industrial nations - Atlantic, Scandinavian, or East European - the growth rate of the health sector has advanced faster than that of the GNP [gross national product]. [2e] Even discounting inflation, federal health outlays increased by more than 40 per cent between 1969 and 1974 [2f]." (2)

ARE WE CONSUMING TOO MANY DRUGS?

As was reported in the Bulletin, March 24, 1992, one of the fastest-growing components of Australia's costly health bill is the pharmaceutical drug trade, which accounts for $2 billion a year for prescription drugs. The Bulletin article reveals that "Australians are on a drug binge, consuming twice as many antibiotics per capita as Sweden and far more than the US and Britain". (3) The situation in the United States and Britain sixteen years ago was bad enough for Illich to write:

"In the United States, the volume of the drug business has grown by a factor of 100 during the current century: [4a] 20,000 tons of aspirin are consumed per year, almost 225 tablets per person. [4b] In England, every tenth night of sleep is induced by a hypnotic drug and 19 per cent of women and 9 per cent of men take a prescribed tranquillizer during any one year. [4c] In the United States, central-nervous-system agents are the fastest-growing sector of the pharmaceutical market, now making up 31 per cent of total sales. [4d] Dependence on prescribed tranquillizers has risen by 290 per cent since 1962, a period during which the per capita consumption of liquor rose by only 23 per cent and the estimated consumption of illegal opiates by about 50 per cent [4e]." (4)

At the time of Illich writing this (1976), it is estimated that 50 to 80 per cent of adults in the United States and the United Kingdom were consuming a medically prescribed chemical every 24 to 36 hours. (5) In his book Confessions of a Medical Heretic (1980), famed medical writer and paediatrician, Dr Robert Mendelsohn, accused doctors of having "seeded the entire population with these powerful drugs". Mendelsohn further states that "Every year, from 8 to 10 million Americans go to the doctor when they have a cold. About ninety-five percent of them come away with a prescription - half of which are for antibiotics." (6)

A recent report by the National Health Strategy (1992) has pointed out that 160 million prescriptions are being dispensed from Australian pharmacies every year, and an estimated further 20 million from hospital pharmacies. (7) This figure represents a 640 per cent increase since 1949, during which 280,719 prescriptions were dispensed. (8)

As reported in Clinical Pharmacology and Therapeutics (1976), a study in a large country town in Australia has revealed that people who reported no illness took as many drugs as those who reported a chronic and acute illness. The authors noted that "the rate of increase in drug usage at around 25 per cent per year can only be explained by increased drug usage of both prescription and OTC [over-the-counter] drugs by the majority of the population". (9) At the time of the report Australians were consuming half the number of prescription drugs compared to today. (10)

Recent figures of how many OTC or non-prescription drugs consumed by Australians are difficult to obtain. Industry sources are reluctant to divulge this information. However, a study by the Health Commission of NSW in 1979 that stated that "at present Australia has one of the leading rates of per capita consumption of analgesics in the world", quoted 1973 figures for sales of OTC medications at $166 million. (11)

It is estimated that in 1991 $1.4 billion was spent on OTC medications, (12) which when added to the $2 billion spent on prescription drugs, (13) totals a staggering $3.4 billion.

DRUGS IN THE FOOD WE EAT

Apart from the vast number of drugs taken directly, people are also unknowingly consuming large amounts of drugs and other chemical substances indirectly from the food they eat. Most food industries rely on chemical substances from soil to supermarket and the animal products industries are by far the most excessive users of these substances. (14) The avalanche of drug and chemical usage by these industries occurred with the shift in production methods from free-range farming to factory and feedlot farming in the last 20 to 30 years. (15)

Over 15 years ago, there were more than 1,000 drug products and as many chemicals in use by the livestock and poultry producers in the United States. (16) Also, more than 40 per cent of the antibiotics and other antibacterials produced every year in the US were used as animal feed additives and for other animal purposes. Almost 100 per cent of poultry, 90 per cent of pigs and veal calves, and 60 per cent of cattle have regular amounts of antibacterials added to their feed. (17) Seventy-five per cent of hogs have their feed supplemented with sulphur drugs (18) and almost 70 per cent of US beef is from cattle fed on hormones to promote growth. (19)

The amount of drugs and chemical substances used on farm animals in the industrialised nations is enormous.

THE CONSEQUENCES

As could be expected, one result of the vast over-consumption of drugs is the astronomical profits generated by the drug industry. Since the beginning of the sixties, drug industry profits (as a percentage of sales and company net worth) have surpassed all other manufacturing industries listed on the Stock Exchange. (20)

Another result is the inevitable deterioration of public health. According to the Food and Drug Administration (FDA), 1.5 million Americans were hospitalised in 1978 as a consequence of taking drugs and some 30 per cent of all hospitalised people are further damaged by their treatments. Every year, an estimated 140,000 Americans are killed because of drug taking (21) and one in seven hospital beds is taken up by patients suffering from adverse drug reactions. (22)

A report by the General Accounting Office in the United States revealed that 51.5 per cent of all drugs introduced between 1976 and 1985 had to be relabelled because of serious adverse reactions found after the marketing of these drugs. These included heart, liver and kidney failure, foetal toxicity and birth defects, severe blood disorders, respiratory arrest, seizures and blindness. The changes to the labelling either restricted a drug's use or added major warnings. (23)

HOW COMMON ARE DRUG ADVERSE REACTIONS?

According to the Adverse Drug Reactions Advisory Committee (ADRAC), the official federal government body responsible for monitoring the safety of drugs already in use: "There is a dearth [scarcity] of published information on the medical and economic importance of adverse drug reactions in Australia." (24) However, a recent study (1991), cited by the National Health Strategy report on drug use, claims that in 1987-88 there were between 30,000 and 40,000 hospital admissions in Australia because of drug taking and also that adverse drug reactions (ADRs) would have been a major factor for between 700 to 900 deaths a year. (25)

There are some who are highly critical of the official estimation of the extent of drug reactions within communities. Dr Julian Gold, head of the National Health Surveillance Unit of the Commonwealth Institute of Health, whose job as a medical epidemiologist is to collate information on the total health environment, estimates that up to 40 per cent of all patients in Australia may actually be victims of doctor induced (iatrogenic) illnesses. (26) A 40 per cent figure has also been estimated for the United Kingdom. (27) Generally of this amount, half are from drug reactions. (28)

UNDER-REPORTING OF DRUG REACTIONS

Many drug reactions go unnoticed. In Controversies in Therapeutics (1980), Dr Leighton Cluff comments:

"National Health statistics do not reflect the magnitude of the problem of drug-induced diseases. A death certificate may indicate that a person died of renal failure, but it may not state that the disease was caused by a drug." (29)

According to a US Senate Select Committee, hundreds of victims of the drug chloramphenicol died undiagnosed in the United States. (30)

Dr Leighton Cluff further states: "Physicians are currently not required to report observed cases of drug-induced diseases to a centralized registry." (31)

In Australia, the reporting by doctors of adverse reactions is voluntary. Postage-paid forms are provided to doctors who are asked to report adverse reactions to ADRAC. Due to complacency, ignorance, and perhaps guilt that their prescribed treatment has caused harm, most doctors fail to fill in these forms.

Even when doctors are willing to report ADRs, there are significant problems that add to the under-reporting of drug reactions. ADRs can sometimes be difficult to identify and Dr Judith Jones, Director of the Division of Drug Experience at the FDA in the United States, has listed three factors that inhibit detection:

1. Difficulty in distinguishing the reaction from underlying diseases, or negative placebo effects.
2. Many ADRs have a silent nature and if not specifically looked for, they may not be found. For example, kidney and liver damage.
3. In multi-drug regimes it is difficult to identify the particular drug which is causing the suspected reaction. (32)

Only 5 to 10 per cent of actual cases are believed to be reported to ADRAC. (33) In the United Kingdom, which has a similar reporting system to ours, only 1 to 10 per cent of cases are revealed. (34) The inadequacy of the reporting system in the UK was demonstrated by the fact that only about a dozen of the 3,500 deaths, later linked with isoprenaline aerosol inhalers during the 1960's, were actually reported by doctors at the time. (35)

Because most adverse reactions to drugs go unreported, the official estimates must be only the tip of the iceberg.

WHO IS TO BLAME FOR DRUG DAMAGES?

Not only do health officials grossly underestimate the extent of drug reactions, they also try to convince the unwary public that drug-related illnesses are largely due to inappropriate drug usage. Officials try to place the onus on consumers and prescribing doctors, and reassure the public that problems rarely occur if drugs are used as prescribed. To protect the drug industry from blame, officials purposely ignore the fact that most drugs are harmful; even if used "appropriately".

EPIDEMIC IATROGENESIS

On doctor or hospital induced illnesses, a once active member of the Doctors' Reform Society and author of the book Medicine Out Of Control (1979), Dr Richard Taylor, writes:

"In fact, because of the increasing complexity of medical technology and the increase in the variety of chemicals available for treatment, iatrogenic disease is on the increase....

"Unfortunately iatrogenic diseases may be self-perpetuating. Many iatrogenic complications require specific treatment, thus exposing the patient to the possibility of yet another iatrogenic disease. A patient may even experience an iatrogenic complication from a diagnostic test which was required to diagnose the initial iatrogenic disease. The situation in which an iatrogenic disease provokes a second iatrogenic complication could be termed second level iatrogenesis. In a hospital setting these situations are not uncommon. It is even possible for third and fourth level iatrogenesis to occur." (36)

Dr Beaty and Dr Petersdorf write in the Annals of Internal Medicine (1966):

"...it should be pointed out that iatrogenic problems are cumulative, and in an effort to extricate himself from complications of diagnosis and therapy, the physician may compound the problem by having to employ manoeuvres that are in themselves risky." (37)

Dr Taylor further explains:

"Every drug administered, every diagnostic test performed, every operative procedure entered into, carries with it the risk of iatrogenic complications. The more medication, tests and operations a patient experiences, the more likely he or she is to develop an iatrogenic disease. Because of the present fragmentation of medical care with each sub-specialist looking after his own particular organ system, the total risk to which the patient is exposed is often forgotten." (38)

Taylor, Beaty and Petersdorf are not alone in their criticisms of allopathic medicine, also known as "modern medicine". More and more physicians and other medical professionals are becoming increasingly disillusioned with their own profession. Allopathic medicine has become more of a band-aid treatment. In their attempts to "patch-up" symptoms of illnesses, doctors are known to use poisonous chemical-based drugs, radical surgical operations and dangerous radiation, which often cause more harm than the original problem.

Apart from introducing more illnesses, allopathic "treatments" mask symptoms of the underlying causes of the illness, which inevitably make it more difficult to detect and treat, and thereby causing it to become more chronic.

Allopathic medicine can be useful and sometimes life-saving for emergency situations (for example, car accidents), yet its harmfulness and ineffectiveness cannot be over-stated.

A prominent critic of allopathic medicine has been the late Dr Robert Mendelsohn, who exposed much corruption in American medicine. Dr Mendelsohn published the following best-selling books: Confessions of a Medical Heretic (39) (1980), Mal(e) Practice: How Doctors Manipulate Women (40) (1982), and How to Raise a Healthy Child...In Spite of Your Doctor (41) (1987). These books are highly recommended.

In Limits to Medicine, Ivan Illich warns:

"The pain, dysfunction, disability, and anguish resulting from technical medical intervention now rival the morbidity due to traffic and industrial accidents and even war-related activities, and make the impact of medicine one of the most rapidly spreading epidemics of our time." (42)

DOCTORS STRIKE: DEATH-RATE DROPS

With the above in mind, it is not surprising that during a one month physicians' strike in Israel in 1973, the national death-rate reached the lowest ever. According to statistics by the Jerusalem Burial Society, the number of funerals dropped by almost half. (43)

Identical circumstances occurred in 1976 in Bogota, the capital city of Columbia; where there, the doctors went on strike for 52 days and as pointed out by the National Catholic Reporter; during that time the death rate fell by 35 per cent. This was confirmed by the National Morticians Association of Columbia. (44)

Again in California a few years later, and in the United Kingdom in 1978 identical events have occurred. (45)

THE SMALL ROLE OF MEDICINE IN MORTALITY

It is important to understand that the vast majority of people are born healthy and, if not tampered with, are "equipped" to remain healthy throughout life. We seldom require intervention with illnesses because the body, as well as the mind, is usually able to defend and heal itself against disease and injury. Only infrequently do we require assistance.

Medical intervention is the least important of the four factors that determine the state of health. The Centers for Disease Control analysed data on the ten leading causes of death in the United States, and determined that lifestyle was by far the most important factor (51%), followed by environment (20%), biologic inheritance (19%), and lastly medical intervention (10%). (46)

According to a classic analysis by Professor Thomas McKeown of Birmingham University, medicine played a very small role in extending the average lifespan in Britain over the past few centuries, the major benefit to people having been improvements in nutrition and public sanitation. (47,48)

Researchers, John McKinlay and Sonja McKinlay came to similar conclusions. They showed that medical intervention only accounted for between 1 and 3.5 per cent of the increase in the average lifespan in the United States since 1900. (49)

The above statistics prove that health depends primarily on prevention, through hygiene and proper nutrition.

In the few instances, when therapy of any sort is warranted, it must deal with the whole person (the holistic approach), treating the actual cause rather than attempting to isolate and suppress symptoms. Allopathic medicine fails in comparison to the holistic approach, and in many instances damages the patient even more than the illness it intends to treat.

Natural medicines and therapies, such as herbalism, homoeopathy, naturopathy, osteopathy and acupuncture, to name a few, work on the holistic approach, and are generally far superior in safety and efficacy than allopathic "treatments".

DRUG COMPANIES BRIBING DOCTORS

A major reason why health care is in such a shambles is that the medical establishment has allowed itself to be bought off by the pharmaceutical industry, whose prime motive is profit. In the book Dissent in Medicine - Nine Doctors Speak Out (1985), Dr Alan Levin writes:

"Health care in the United States has become a megabillion-dollar business. It is responsible for over 12 percent of the gross national product. Revenues from the health industry, which currently exceed $360 billion a year, are second only to those of the defense industry. True profits are much higher. [In 1991 the US had spent $750 billion on health care. It has been estimated that by the year 2000, annual health care costs in the US will have increased to at least 1.5 trillion dollars. (50)] It is not difficult, then, to see why this industry is so appealing to corporate investors. Many industrialists determined to profit from health-care products have encountered one major obstacle: Practicing physicians remain the primary distributors of health care products. Physicians, who have traditionally existed as independent entrepreneurs do not fit easily into the corporate mind-set. If corporations did not have control over their distributors (the physicians) they would not be able to guarantee profits to their stockholders.... Thus, we need not wonder why senior executives of major health care-oriented corporations have decided to woo physicians into their camps.

"Pharmaceutical companies have curried the favor of practicing physicians for many years... As the cost of development and marketing of pharmaceuticals increased [during the 1960's], the drug companies efforts to attract the allegiance of practicing physicians intensified.

"Not only did drug company operation costs increase markedly, but the rewards of the marketplace rose tremendously.... The increase in revenues brought competition which led to a nationwide increase in drug advertising. Advertisements in medical journals and public magazines were popularized by carefully controlled news releases associated with 'medical breakthroughs.'

"These advertising efforts, which began with gifts to practicing doctors and medical students, have become a massive campaign to mold the attitudes, thoughts, and policies of practicing physicians. Drug companies hire detail men to visit physicians' offices and to distribute drug samples. They describe the indications for these drugs and attempt to persuade physicians to use their products. Like any other salesman, they denigrate the products of their competitors while glossing over the shortcomings of their own. Detail men have no formal medical or pharmacological training and are not regulated by any state or federal agencies. Despite their lack of training, these salesmen have been very effective. Their sales campaigns have been so successful within the United States that the average physician today has virtually been trained by the drug detail man. This practice has led to widespread overuse of drugs by both physicians in their everyday practice and the lay public.... With the exception of heroin and cocaine, 85 percent of all drugs currently abused in the streets are manufactured by 'ethical' drug companies.... Gross sales forecasts from these 'ethical' drug companies deliberately include profits made from illicit sales to drug peddlers.

"The drug industry woos young medical students by offering them gifts, free trips to 'conferences', and free 'educational material.' [Emphasis added.] (51)

A double page article titled "$200m 'bribe' to lure our doctors", appearing in the Sun Herald (August 18, 1992), reported that:

"Drug companies spend a massive $200 million every year in Australia on marketing their products... That represents almost $10,000 a year spent attempting to woo each of Australia's 21,000 'actively prescribing' GPs, according to Dr Ken Harvey from La Trobe University."

The article cited Theo van Lieshout, secretary of the NSW Doctors' Reform Society as saying that 50 per cent of drugs on the market did not exist 10 years ago - and doctors had not learned about them in medical school. Busy physicians therefore rely mainly on drug company sales staff to tell them about new medications.

As reported in the Bulletin (March 24, 1991), Dr Ken Harvey stated: "The students concede concern. The problem is, after five years out in practice, with six drug reps a week coming in, they have gone away from prescribing sensibly and by scientific name to prescribing the brand promoted by the last rep who walked in." (52)

UNIVERSITY SCIENTISTS - THE WILLING PAWNS

Drug companies employ many means in bribing doctors and medical institutions. Dr Levin writes:

"Young physicians are offered research grants by drug companies. Medical schools are given large sums of money for clinical trials and basic pharmaceutical research. Drug companies regularly host lavish dinner and cocktail parties for groups of physicians. They provide funding for the establishment of hospital buildings, medical school buildings, and 'independent' research institutes.

"The pharmaceutical industry has purposefully moved to develop an enormous amount of influence within medical teaching institutions. This move was greatly facilitated by several factors. The first was the economic recession, which caused a marked constriction in federal funding for research programs. Academic scientists lacked funding for pet research projects. The second was the tremendous interest that academic scientists held in biotechnology, the stock market, and the possibility of becoming millionaires overnight. The third is the fact that academic physicians tend to lack real clinical experience. In the university, the physician is an expert in esoteric disease, end-stage disease, and animal models of human disease. He or she has little or no experience with the day-to-day needs of the chronically ill patient or the patient with very early symptoms of serious illness. As the academic physician does not depend upon the good will of the patient for his or her livelihood, the patient's well-being becomes of minor consideration to him or her. All these factors make the academic physician a very poor judge of treatment efficacy and a willing pawn of health industrialists.

"Pharmaceutical companies, by enlisting the aid of influential academic physicians, have gained control of the practice of medicine in the United States. They now set the standards of practice by hiring investigators to perform studies which establish the efficacy of their products or impugn that of their competitors....

"Practicing physicians are intimidated into using treatment regimes which they know do not work. One glaring example is cancer chemotherapy....

"Your family doctor is no longer free to choose the treatment modality he or she feels is best for you, but must follow the dictates established by physicians whose motives and alliances are such that their decisions may not be in your best interests. [Emphasis added.]" (53)

Dr Alan Levin is an Adjunct Associate Professor of Immunology and Dermatology at the University of California. He is a Fellow of the American College of Emergency Physicians, the College of American Pathologists, and the American Society of Clinical Pathologists. Dr Levin is also a recipient of fellowships and awards from Harvard Medical School and other medical institutions, and was Director of various research laboratories.

Ivan Illich echoes Levin's last comment: "The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic." (54)