Tuesday, December 11, 2007

APA Report Rips Pharma a New One!

A task force of the American Psychological Association (APA) recently published a report that listed more than half a dozen ways the pharmaceutical industry exerts "enormous financial and political influence" that enables it to "assume a significant role in directing medical treatment, clinical research, and physician education" (see "Corporate Funding and Conflicts of Interest - A Primer for Psychologists").

The report also recommended that its 148,000 members "turn their nose up at pharma funds; limit the role industry plays at professional conferences, meetings and CME sessions; and adopt strict guidelines on conflict-of-interest disclosure" (see "Psychologists Urged To Upgrade Ethics Rules").

According to the APA, the drug industry exert enormous financial and political influence over most aspects of the US health care, including nonprofit patient groups, physicians, professional and academic institutions, the U.S. Congress, and the Food and Drug Administration (FDA).

APA points out that the two largest associations representing the pharmaceutical and biotechnology industries are headed by former congressmen who previously chaired committees relevant to those interests.

We all know Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America, from the exploits of PhRMA Intern as chronicled in this blog (see examples here).

U.S. Representative James Greenwood left his position as chairman of the House Committee on Energy and Commerce Subcommittee on Oversight and Investigation to become the president and CEO of the Biotechnology Industry Organization (BIO) in 2005. At the time, I remember Greenwood citing the need to send his two daughters to college as a reason why he abruptly switched to the dark side.

With two former congressmen heading up their lobbying groups, is it any wonder that the pharmaceutical industry has the largest lobbying force of any industry, as claimed by APA?

"The pharmaceutical and health products industry spent $612 million on lobbying from 1998 to 2005," says the APA report, "working on more than 1,400 congressional bills."

According to the APA, "pharmaceutical industry money is so crucial to the funding of university medical centers that no threats or offers need to be made for a company to exert its influence."

OK, that's NOT strictly true. Threats and offers ARE made. Recall the story of Dr. Buse who was threatened by GSK (see "Dr. Buse Under GSK's Thumb! How Pharma Uses CME Funding as a Weapon").

The APA report does not neglect to mention the marketing: "In 2001, the pharmaceutical industry spent over $19 billion on marketing. It has been estimated that $35 billion was spent that year on 'marketing masquerading as education' and 'marketing masquerading as research,' costs that were then passed on to the public via higher retail prices for the medicines they purchased."

While I think the drug industry wastes a lot of money on marketing and does masquerade some marketing activities as education, I don't buy the argument that this raises the retail price of medicines. What it does is take money away from other areas where it should be invested -- like more clinical research. That is, if pharma were not able to spend so much $ on marketing, it would either plow that money into research or give it back to investors as dividends. It certainly would NOT lower retail prices. Who ever heard of any company ever doing that? -- except WallMart, which denies medical insurance to many of its workers.

Pharma Presence at APA Annual Meeting Led to Report
What caused the APA to set up its Task Force on External Funding that issued this report? It was the industry itself, of course.

Philip Zimbardo, former president of the APA, was appalled by the extravagant exhibits sponsored by pharmaceutical companies at the 2002 annual APA convention.

[On the left is one small example of how drug companies try to influence physicians at conventions.]

Philip Zimbardo observed the following at the 2002 American Psychiatric Association convention:
Dozens of huge exhibits, many occupying at least 250 square feet in area, most of which at least 20 feet tall, filled the center of the convention arena, on separate "islands" (stand-alone exhibit areas). In addition to their sheer bulk, many displays featured the name of the primary drug being promoted more prominently than they did the name of the pharmaceutical company.

Moreover, they were each staffed by large sales forces (as many as 15 for any one exhibit) wearing colorful logo shirts or uniforms. [What? No scantily-clad female models? I bet there were at least some good-looking women at the booths, even if they were dressed in pancreas costumes!]

In addition to providing information to attendees, the sales representatives were there to give away a variety of commercial gifts, administer unvalidated tests, and engage in other promotional activities. [Well, duh! These are commercial exhibits.]

These large booths were also filled with an assortment of unusual features to attract attendees, such as Zen gardens (10 feet long), aquaria, relaxing music listening areas, mazelike tunnels in which audio and video presentations simulated the psychotic experience, a music shack where attendees had their photo taken while playing a musical instrument that was made into the cover of a gift blues music CD for them [Wow! Way cool!], large sculptures, and more.

These exhibits were so big and so complicated that each required three or four days to assemble and several days more to disassemble. One exhibit booth alone cost more than $450,000 to create, according to the design coordinator -- and it was to be used only at one convention of the American Psychiatric Association. [Think how much MORE could have been spent if the sponsor didn't waste so much money on DTC advertising!]

A reporter covering the event for The Washington Post also described the scene: "In one part of the convention hall, companies erected 20-foot-high monuments to their medicines and handed out promotional materials, candies and gifts."

In a further illustration of the industry's influence on the convention, the reporter noted, "And in several dozen symposiums during the weeklong meeting, companies paid the [American Psychiatric Association] about $50,000 per session to control which scientists and papers were presented and to shape the presentations."


  1. Anonymous8:56 AM

    Isn't there a natural bias since psychiatrist are able to prescribe drugs, while in most (or is it all) states, psychologists cannot. Undoubtedly, this is a conflict of interest on the part of the American Psychological Assn.

    Of course, pharma does have a powerful lobby, but so do the health plans, PBMs, the AMA, NAMI, the NRA, the oil industry, and many others. Last I checked, the right to lobby is covered by the 1st Amendent.

  2. Alex,

    Thanks for your comment.

    I don't think anyone is suggesting to take away pharma's "right" to lobby. I also have the "right" to lobby, but I doubt if I'd get even close to a US Senator! If I donated a lot of money to that Senator's re-election committee, then I MIGHT have a shot!

    Regarding the link between marketing and high drug costs, I had this thought: do high drug costs in the US finance the high cost of direct-to-consumer advertising? That is, drug prices are not high because DTC causes doctors to prescribe higher-cost drugs, but because pharma needs to bankroll its marketing machine. I guess it's a kind of vicious circle. Although there may be a link, I still don't believe that limiting DTC will result in lower drug prices.

  3. Anonymous1:33 PM

    Ha! In a previous lifetime I worked at the agency that conceived and designed that huge maze-like tunnel at the 2002 APA. Was it extravagant? Perhaps. But it was also very innovative and effective

    One thing you have to remember is that when it comes to exhibits, it's not just the Pharma company that wants to up the ante, but also the agency's designers--creative people by nature--who want to challenge themselves and push the artistic and technological envelopes.

    That is, it wasn't big and complex for the sake of being big and complex; instead, we had a (rather large) budget, and used it to make something completely original, dramatic, and at the time, quite advanced. (Trust me, these were not merely audio and video presentations, as if you just walked from screen to screen. This was--and forgive the agency-speak--an immersive 1st-person experience more akin to something you'd see at Epcot.) And for that, we were very proud and happy. And our client was happy that they had people lining up around the booth every day waiting to walk through it.

    If I remember correctly, it really only took 2 full days for setup and breakdown...maybe 3. And we did use it at other meetings besides APA.

    While some might look at that exhibit as a monstrosity, a sign of Pharma excess of the times, or an affront to medical congresses, from a purely creative point of view, it was probably the most amazing project I've ever been involved with just from the sheer challenge and scope.

  4. I know what you mean about an amazing creative experience... especially when using someone else's money!

    In a previous life, I designed computer-based pharmaceutical sales training programs. One project i worked on (in 1993 or thereabouts) used interactive video, animation, blue-screen live actors superimposed over computer-generated 3-D backgrounds, etc. All delivered on videodisc! Remember that?

    It was a take-off on Fantastic Voyage -- in our case, actors playing sales reps were "shrunk down and injected" inside a body to fight off an infection with a new antibiotic! The audience -- real sales reps at a product launch meeting -- helped them along their journey using an audience polling system to answer questions. The system controlled the videodisc sequence as well as displayed polling results in bar graphs.

    To create the 3-D vessel, we used the same software that was used to create Robocop!

    I really learned a lot about the technology available at the time -- and you know what? Even with the mega-advanced technology of today, I haven't seen anything to compete with it! It cost about $300,000 and was probably used only once.

  5. Anonymous2:46 PM


    Sounds like a very cool experience and program--probably ahead of its time, indeed. It really is fun experimenting with other people's money!

    You're also right about general booth creativity/quality. I go to 4-6 major meetings/year, and although I go for scientific reasons now, I do keep an eye out for what designers are doing these days, and it's rare that I see something that really impresses me. Mostly the same stuff recycled over and over again. Then again, I don't think the budgets are what they used to be... There was a pretty cool, large, Minority Report-like display at EULAR in Barcelona last spring -- I forget whose booth it was, though. Now that I think about it, I suspect we'll be seeing a lot of iPhone-inspired display interfaces over the next year...

    Videodisc? Good lord!


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