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What do Celebrex, Paxil, Propecia, Viagra, and Xenical have in common? (A) They are not used to treat life-threatening conditions. (B) Their manufacturers spend millions of dollars to advertise them directly to consumers. (C) They contributed to a record $111 billion worth of prescription drug sales last year. (D) They got a plug in "Pro Pharma," the lead essay in the October 29 New York Times Magazine.
The answer is all of the above, and Andrew Sullivan should be ashamed of his essay, which is a facile argument for unfettered drug prices. Shilling for the drug industry in the Times is the equivalent of giving a blow job in Macy's window, and Sullivan left nothing to the imagination. Sample sentences: "I love America's pharmaceutical companies. . . . Their products are among the most popular around. . . . In the last 10 years, with the possible exception of information technology, no industry has more thoroughly transformed our lives."
In recent weeks, Sullivan had a falling-out with The Advocate, after calling the mag's Bill Clinton interviewer a bootlicker. But his plunge into the drug tank is a new low in an ever controversial career. After graduating from Oxford, Sullivan quickly realized his pundit potential as a gay Catholic conservative, becoming editor of The New Republic in 1991. He resigned in 1996, around the same time he announced he had HIV, and his byline has been in demand ever since. Meanwhile, many fans in the gay community feel he has sold out to the right.
But as a free-market advocate who is living with HIV, Sullivan is the perfect poster boy for the pharmaceutical industry. He's a gym rat who can squat more than 400 poundsand he takes about 15,000 pills a year at a cost of $15,600, every penny of which is paid for by his insurance. Who better to pitch Big Drugs to the Times' demographic?
If you read it uncritically, Sullivan's prose goes down easy. But remove the sentimental narrative and slick graphics, and "Pro Pharma" carries as much punch as a placebo. The case goes like this: We make more and better drugs now, we take more than ever, and we're all more productive because of it. Some people say drugs cost too much. But if we regulate profits, the companies won't be able to make such great pills. They need that money to pay for the drugs of the past, present, and future. Sure, only rich people can afford the new drugs, but once the patents run out, poor people will get the generics. What's not to like?
At the center of "Pro Pharma" is the industry's no-profits-no-innovation argument. But not everyone buys the rhetoric. In a recent issue of The American Prospect, New York University professor Merrill Goozner called the industry argument a "tidy story" that "falls apart under scrutiny." Goozner argues that the industry exaggerates the cost of developing new drugs, takes credit for products that were developed largely in the public sector, and charges inflated prices for drugs that are not significantly more effective than those they were designed to replace.
Goozner, a former economics correspondent for The Chicago Tribune, gives the Times credit for some excellent news reports on drug marketing this year. But he has low regard for Sullivan's piece, which he feels is irresponsibly one-sided. "This subject is so freighted with controversy," says Goozner, "that you can't write a story like that without me feeling some basic code of journalistic conduct has been violated."
One thing Sullivan forgot to mention is that drug sales are influenced by the drug companies' promotional budgets. In 1999, the industry spent $24 billion on research and development, and more than half as much ($13.9 billion) on promotion. "Promotion" typically includes marketing to doctors, billions of dollars worth of free samples, and direct-to-consumer (DTC) advertising. Since the Food and Drug Administration relaxed restrictions on TV ads in 1997, spending on DTC drug ads has risen sharply, reaching a record $1.8 billion last year.
According to a recent study by the nonprofit National Institute for Health Care Management (www.nihcm.org), 40 percent of last year's increase in drug spending can be attributed to 25 heavily promoted new drugs. These are not lifesavers, typically, but lifestyle drugs and new formulas that are touted as superior to the drugs they were created to replace. According to Steven Findlay, who wrote the NIHCM study, prescription drug revenues increased by about 60 percent during the four-year period from 1996 to 1999. While the growth is driven largely by consumer demand, he says, that demand is driven in part by "aggressive marketing" by the drug companies.
Sullivan is "taking some cutting-edge medicines for a life-threatening illness," says Findlay, "and you can't dismiss the perspective of people in his situation. They think the pharmaceutical industry is serving their needs, and they're right." But, Findlay suggests, some drugs merit the hype, and some don't. According to the NIHCM study, some "people are beginning to ask their doctors for newer and costlier medicines when less expensive drugs may work just as well."
Findlay says the drug industry has been putting out the no-profits-no-innovation argument "for 25 years or more, and they have gotten away with it." But now, he says, "a lot of people, including many in Congress, have begun to question that. Are consumersand not just shareholdersbenefiting enough from the sustained high profit margins in the drug industry? Are companies really pouring the money back into truly innovative products? It's not clear."