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New World War: Revolutionary Methods for Political Control

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Volume I: Current Political Situation


Volume II: The New War


Volume III: Weapons of The New War


Volume IV: The Coverup


Appendix


Control of the Medical Industry
Manipulation of Washington

In order to understand how an entire medical system consisting of a multitude of seemingly independent organizations has been providing complete cover for this war against citizens, and is used to attack them, it will be instructive to show that upon closer observation we find that these organizations function as a single complex, which is tightly controlled from the top by the pharmaceutical industry.

Pharmaceutical companies basically run Washington through their agent lobbyists, many of which are former federal employees. These lobbyists work for corporations to promote their issues in the House, Senate, the FDA, the Department of Health and Human Services (which includes the National Institutes of Health), and executive branch offices.

Between 1998 and 2004 the pharmaceutical industry spent more money lobbying Congress than any other industry. The industry now has two lobbyists for each member of Congress and is said to be able to thwart attempts to regulate its practices. In addition to each member of congress being influenced by lobbyists, some have received hundreds of thousands of dollars from drug corporations in the form of campaign contributions.

The industry’s influence in Washington can be traced back at least to the first Bush administration. George H. W. Bush was on the board of directors for Eli Lilly after leaving the CIA, and before running for vice-president in 1980. As Vice President, he began weakening the FDA’s approval process for all drugs.

Dan Quayle’s campaign to become senator of Indiana was heavily funded by Eli Lilly. Then, as Vice President, Quayle recruited former Eli Lilly employees on his staff. In 1988 the Bush-Quayle administration allowed Eli Lilly to restructure the FDA’s approval process to suit their needs.

“Washington is the axis of the industry’s power,” proclaimed Melody Petersen, a former health reporter for the New York Times. Drug corporations have a tremendous influence on the practices of federal agencies such as the National Institutes of Health (NIH), and the Food and Drug Administration (FDA).

National Institutes of Health

The National Institutes of Health (NIH) consist of about 27 federal research centers and institutes, (including the National Institute of Mental Health), that are known for their scientific research on behalf of the public. Officially founded in 1938, it was the federal government’s first research institute for combating epidemic diseases.

The NIH is partially funded by drug corporations. In addition, many of the NIH’s senior doctors have significant ties to drug corporations. These officials have made hundreds of thousands of dollars consulting for the industry while serving at the NIH, as reported on December 7, 2003 in the Los Angeles Times.

Records obtained by the Times document hundreds of consulting payments to top ranking NIH officials. To cover the story, the Times obtained federal records such as Freedom of Information Act (FOIA) requests from the FDA, filings with the Securities and Exchange Commission, lawsuits, as well as information available on drug company web sites, and many interviews.

Dr. Stephen Katz, Director of the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, collected at least $470,000 from the industry in the last decade. Beginning in 1997 up to about 2003, the director of the NIH’s Clinical Center, Dr. John I. Gallin received at least $450,000 in fees and stock options. The NIH’s top diabetes researcher in 1997, Dr. Richard C. Eastman, received funds from the industry while advocating a product that was later linked to liver failure.

Dr. Ronald N. Germain, the deputy director of a major laboratory at the National Institute of Allergy and Infectious Diseases, was paid at least $1.4 million over an 11-year period beginning in the early 1990s. Over a 10 year period, Dr. Jeffrey Schlom, director of the National Cancer Institute’s Laboratory of Tumor Immunology and Biology, was paid over $300,000 by the industry.

Jeffrey M. Trent received up to $160,000 in consulting fees from the industry between 1993 and 1996 while serving as the scientific director of the National Human Genome Research Institute. The director of in-house research at the National Institute of Allergy and Infectious Diseases, Dr. Thomas J. Kindt, accepted about $63,000 in consulting fees.

Dr. P. Trey Sunderland, an expert on Alzheimer’s disease, received more than $500,000 between 1998 and 2004 from the industry for dozens of speaking tours all over the world. These and other NIH connections to drug corporations were approved by the deputy director of the NIH, Dr. Ruth L. Kirschstein, who commented, “I think NIH scientists, NIH directors and all the staff are highly ethical people with enormous integrity.”

Most information regarding corporate payments to NIH doctors are not publicly available. NIH policy now allows about 94% of its senior employees to keep their consulting income confidential.

National Institute of Mental Health

A component of the NIH, the National Institute of Mental Health (NIMH) is a federally funded agency which deals with issues relating to mental illness in America. It sponsors a variety of “awareness raising” campaigns which are funded in part by drug corporations. An example of this would be Eli Lilly’s multimillion dollar “Depression Awareness” campaign to promote Prozac.

Dr. Peter R. Breggin, author of the book, Brain-Disabling Treatments in Psychiatry, Drugs, Electroshock, and the Psychopharmaceutical Complex, says that while he was a full-time consultant to the NIMH from 1966 to 1968 it sought ways to improve the nation’s mental health through social, educational, economic, and psychological methods. However, it underwent a transformation in the 1970s when organized psychiatry and drug corporations established control over it.

The NIMH conducts highly expensive clinical studies on behalf of these corporations to promote their products. In addition, it publishes a massive amount of literature pertaining to mental illness, much of which benefits drug corporations and organized psychiatry.

“Both the FDA and NIMH,” commented Dr. Breggin, “Are now agents of the psychopharmaceutical complex. They do virtually everything in their power to promote biologically oriented psychiatry and the products of the psychopharmaceutical industry.”

Food and Drug Administration

The Food and Drug Administration (FDA) which is responsible for the drug approval process and determines whether or not a drug should be withdrawn, also has financial ties to the industry. The FDA does not perform its own independent studies during the drug approval process because it lacks the funding to do so. The FDA relies on data furnished by drug corporations while evaluating their products.

The FDA relies almost entirely on information that has been gathered, organized, and interpreted by drug corporations. Dr. Breggin elaborated, “All of the studies involved in the FDA approval process are designed completely by the drug companies and conducted by physicians hired and paid for by them.”

In addition to relying almost entirely on information provided by drug companies, the FDA will solicit funds from them to expedite the approval process. The division of the FDA that approves new drugs receives more than half of its funding from drug corporations. And between 1993 and 2001 it received about $825 million from the industry.

Front Groups
Description

Front groups have the appearance of serving patients and the general public by providing information and advocacy, but have in fact been created or infiltrated by drug corporations, and are used as a facade to boost their sales. They include professional societies and independent organizations such as patient advocacy groups.

Drug corporations not only sponsor these organizations, they usually have strong financial ties to the academic physicians that provide the groups’ educational material. Under the guise of educating the public, these groups produce books, web sites, and other initiatives to promote prescription drugs.

Professional Societies

Many medical professional groups have financial ties to drug corporations which have a direct influence on their publications. Some have guidelines on the amount and types of gifts they can accept, but there are many other ways that physicians can be bribed. And some appear to be violating their own rules.

A few of the societies under the industry’s influence or control include: the American Thoracic Society (ATS), the Society for Critical Care Medicine (SCCM), the Endocrine Society, the American Psychiatric Association (APA), the American College of Physicians (ACP), the American Heart Association (AHA), the American Medical Association (AMA), and others.

These societies hold annual conferences where awards funded by and named after drug corporations are given to its members, such as the Eli Lilly and Company Research Award of the American Society of Microbiology, The American Psychiatric Institute for Research and Education (APIRE)/GlaxoSmithKline Award, etc. In addition, they form panels of experts consisting of their members who produce clinical practice guidelines (CPG), which other physicians use daily as diagnostic tools.

The American Psychiatric Association (APA), representing most of the psychiatrists in the US, is said to be completely dependent on funds from drug corporations. Its national conferences are also funded by millions of dollars from the industry. Drug corporations also support the APA’s efforts to lobby congress for favorable legislation.

Operating through these professional organizations, drug corporations initiate projects to portray their prescription drugs in a favorable manner. They may offer ghostwritten articles to physicians, select speakers for meetings, and provide authors of CPGs who assist the corporations in their marketing objectives.

In addition to the societies themselves receiving funds from corporations, the committees or panels that these professional societies create to produce CPGs, typically include individual physicians with financial connections to the industry. These professional organizations may receive unrestricted grants from drug corporations.

In his book On the Take: How America’s Complicity with Big Business Can Endanger Your Health, Dr. Jerome P. Kassirer describes these professional societies as marketing agents for drug companies. He explained: “From the many complex arrangements, it is apparent that physicians and medical professional organizations with close financial ties to industry are intricately involved in developing clinical practice guidelines and a variety of new industry-sponsored pamphlets, books, web sites, registries, and quality initiatives.”

Patient Advocacy Groups and Nonprofit Organizations

At least two-thirds of consumer advocacy groups (also called patient advocacy groups) are funded by drug corporations. They include the National Alliance for the Mentally Ill (NAMI), Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), and others. These groups hold national meetings where drug advocates interact with patients.

These corporate-funded groups produce books, web sites, pamphlets, and other material to promote the use of prescription drugs to alleviate supposed mental disorders. They suppress altering views and promote the belief that there is a tremendous underdiagnosis of mental disorders. In addition, they provide a network of suffering patients to perform patient testimonials for PR firms hired by drug corporations during their “awareness raising” campaigns.

CHADD receives about $700,000 from the industry annually. Some groups are more heavily funded, although it unknown exactly how much most of them receive because they don’t disclose their sources.

NAMI is the largest patient advocacy group in the US for people with mental disorders. NAMI works with drug corporations to lobby congress to create legislation that benefits the industry. From 1996 to 1999 it received $11.7 million from 18 drug corporations, including GSK, Wyeth, and Eli Lilly. From 2006 to 2008 NAMI received almost $23 million from the industry.

In addition to being financed heavily by the industry, NAMI’s executive director, Michael Fitzpatrick, has frequently met with sales representatives from corporations such as AstraZeneca, who provided direct advice about how to advocate forcefully for issues that affect industry profits, as reported in the New York Times in October of 2009.

US Senator Charles Grassley, who began a congressional investigation in 2008 into drug company influence on the medical community, had this to say about these groups: “I have come to understand that money from the pharmaceutical industry shapes the practices of nonprofit organizations which purport to be independent in their viewpoints and actions.”

The American Medical Association (AMA) is a nonprofit organization that receives funding from the industry. The free distribution of its journals, including the Archives of General Psychiatry, and the Archives of Internal Medicine, is made possible by drug company advertising.

Before 1951 it was a truly independent organization with its own laboratory which it used to determine the effectiveness and safety of drugs. Drug corporations were not allowed to advertise in its journal, the Journal of the American Medical Association, unless their products were worthy of the AMA seal.

Then in 1950 it received about $2.5 million from the industry from advertisements in its journals. A decade later it received about $10 million. Gradually it removed its critical stance toward the industry, stopped publishing its books on useful drugs, and abandoned its seal of approval.

One of the nation’s leading nonprofit mental health associations, Mental Health America (MHA), formerly the National Mental Health Association (NMHA), also receives money from the industry. In 1993 Eli Lilly contributed about $3 million to MHA, which resulted in promotional campaigns in the form of TV commercials by the MHA pleading with potential patients to see their doctors if they thought they were depressed.

MHA has since received millions in financing from drug corporations. In 2008 alone the organization received over $1 million from the industry, with $500,000 from Pfizer and $600,000 from Eli Lilly. Dr. Nada Stotland, current board member of the MHA and 2008 president of the APA, is currently on the speakers bureau for both Pfizer and GSK.

The Industry’s Influence of Doctors
Recruitment

The majority of the industry’s marketing is directed at recruiting physicians. The reason is that each doctor may write millions of dollars worth of prescriptions during their careers. Plus, the physicians interact directly with patients and usually have their trust. Drug corporations even rank some physicians according to their lifetime prescribing potential.

The recruitment of physicians begins in academic medical centers and hospitals where they are identified by pharmaceutical salespeople called detailers. The detailers frequently visit these facilities to aggressively promote drug products while providing meals and gifts to students.

According to the New England Journal of Medicine, medical students receive a substantial amount of meals and other favors from drug corporations. The students are often invited to what the Journal describes as quasi-social events, where they hear industry-sponsored lectures. All of this is done with the approval of the teaching facility.

Apparently the industry capitalizes on the susceptibility of students who are usually tired, and who need encouragement, kindness, and free food. “Drug company representatives appreciate these vulnerabilities and needs, and step in to help,” observed Dr. Kassirer.

Dr. Kassirer witnessed a typical one of these put out by Pfizer, where two well-dressed detailers in their late 20s provided a buffet for a teaching conference. One was stationed at the beginning of the line, the other at the end. As the students arrived, each was engaged by the detailers in small-talk such as “How are you?” “How are you doing?” etc., then they would be given information regarding a new drug.

In their book, Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning us All Into Patients, authors Ray Moynihan and Alan Cassels, describe the recruitment process this way: “The entanglement starts with free pizzas for the hard-working hospital residents and interns, and from then on it never stops.”

They continued: “As US physicians graduate from the hospital wards out into their own practices, there to greet them daily is an eighty-thousand-strong army of drug company representatives [detailers] ... always ready with a smile, some warm doughnuts, and a dose of friendly advice about the newest drugs and the latest diseases.”

After graduation, physicians are usually in debt from educational loans, which make them particularly vulnerable to the financial rewards provided by drug corporations. In addition, they often see their senior role models lavishing themselves with these gifts. So, they begin by accepting meals and gifts, then, reportedly, some even demand industry donations as their careers advance.

There is a silent progression, illustrated Dr. Kassirer, from the innocence of accepting gifts and food to a later bland and unquestioning acceptance of pharmaceutical money by physicians as their careers advance. “With no restrictions,” proclaimed Petersen, “nearly 95 percent of American physicians now line their pockets with corporate lucre.”

Practicing Physicians

Those not recruited during med school may later be aggressively targeted by detailers who visit practicing doctors at their offices and can be seen all over hospitals and academic medical centers ... always providing gifts. They frequently deliver meals for conferences at these establishments. And in some cases, physicians in private practice as well as heads of departments at hospitals will directly solicit drug corporations for meals.

Some gifts have included: TVs, VCRs, theater tickets, dinners at local restaurants, PDAs, concerts, tickets to sporting events, gift certificates, all-expense paid trips to resorts with honorariums of up to $2,000, meals delivered to their offices, etc. According to Dr. Kassirer, it is incredibly simple to recruit physicians because the deals they’re offered by drug corporations are impressive.

There is now at least one detailer for every six physicians. Each one has an expense account that allows them to provide doctors with gifts, meals, and cash payments. Petersen cites a manual she was able to read by Tap Pharmaceuticals, which mentioned that detailers should expect hospitals and private practice doctors to ask them for cash. The detailers would deliver the money on the condition that the doctors would write more prescriptions.

Some of these gifts are offered under the guise of “educational” expeditions. The industry has arranged it so that hundreds of supposedly independent doctors can be flown to a resort, informed about a company’s new drug, and paid for attending.

Pfizer has done this. And physicians have received up to $1,000 for attending one-day workshops by Merck. Those who are willing to give talks about the products receive additional money. The attendees of the expeditions may then be added to the company’s paid stable of speakers.

Some receive phone calls from representatives of drug corporations asking them to listen to “educational” programs over the phone, for which they may receive $100. In addition, free dinners sponsored by corporations are also offered, which include educational seminars about new drugs.

Some drug corporations even pay physicians or pharmacies to allow them to view their patient’s files. Private practice doctors may receive up to $4,000 for enrolling individual patients in drug trials. They reportedly make tens of thousands of dollars a year from this, in addition to their regular salary. Furthermore, they may be used as expert witnesses in lawsuits against drug corporations.

In the area of psychiatric drug testing, organizations make as much as $40,000 for each patient that they successfully convince to complete a drug trial. The Office of Clinical Trials at Columbia University, for instance, receives about $10 million per year from drug corporations for enrolling patients to test new medications.

“University psychiatry departments, private research clinics and some individual doctors live on this money,” declared Dr. Loren R. Mosher in his article, Are Psychiatrists Betraying Their Patients?, which appeared in the September/October 1999 issue of Psychology Today.

Most physicians with ties to the drug corporations swear they could not be influenced by a financial conflict of interest. According to the New England Journal of Medicine, many physicians become outraged when it’s implied that their financial ties to these corporations affect their work. They insist that, they cannot be bought, that no matter what the blandishments, they can remain objective.

However, says Dr. Kassirer, “this posture ignores what we know about human nature and the powerful influence of money.” Studies show that physicians are influenced by the industry’s gifts. The drug corporations are certainly convinced of this, which is why most of their marketing money is spent not on the public, but on the doctors—the agents whom the public interact with.

To prove his point, Dr. Kassirer cites the rule of reciprocation described by Professor Robert Cialdini, Regents Professor of Psychology and Marketing at Arizona State University. The rule states that we tend to give back to others what they’ve provided for us.

Professor Cialdini discovered that reciprocation is a very powerful motivator after studying the persuasive tactics of salespeople, fund-raisers, advertisers, and PR firms. Providing favors and gifts are important tactics used to obligate people to return favors.

In fact, reciprocation is the first rule in Professor Cialdini’s weapons of influence for getting others to do your bidding. This has worked even when the exchanges are unequal. For instance, a small gift has been given, which influences the receiver to repay a larger amount to the giver. An effective way to place someone in debt, according to this rule, is by delivering persistent uninvited favors over a period of time. According to Petersen, almost all American doctors accept these gifts.

In an August 2008 interview on National Public Radio, Professor Cialdini portrayed his arsenal of influence like this: “For the last 50 years, what’s developed is a solid science of persuasion.” He described it as a scientifically grounded set of rules that, if used, increase the likelihood that people will respond favorably. “It’s all in the science of knowing how the rule for reciprocation works in our society,” he explained.

Further Education

Most states require physicians to take about 50 hours of instructions each year as part of their continuing education. These may occur at resorts which doctors are flown to, workshops, annual conferences, over the phone, or dinners where speeches are given. In many cases the doctors receive pay for attending.

Almost half of the refresher courses themselves are funded by drug corporations and take place at their various venues. Furthermore, many medical and psychiatric textbooks, which are used as the educational material, are written by consultants with strong ties to drug corporations.

The pharmaceutical industry has become increasingly interested in funding continuing medical education, according to The Boston Globe. For instance, the Massachusetts General Hospital psychiatry department raised about $6.5 million from Cephalon, Janssen, GSK, and Wyeth for its 2005 continuing education program which provided lectures to doctors nationwide.

The lectures were to be offered at hospitals, medical schools, and educational companies, as well as teleconferences, and webcasts. Many of the psychiatrists who teach the courses are consultants for, or receive research funding from, drug corporations.

As much as they prescribe these drugs, most doctors know little about them, says Dr. Breggin. And the information they receive pertaining to them is often provided in the form of advertisements funded by the industry.

Dr. Jerry Avorn and his colleagues at Harvard Medical School found that when a group of doctors where asked about the properties of certain prescription drugs, their answers resembled information in drug advertisements rather than scientific literature. Only very few become experts on prescription drugs, but these people are typically not an unbiased source of information because they’re almost always heavily connected to the industry.

Moynihan and Cassels advised, “Many of our doctors, no matter how committed and hardworking, are still prescribing under the influence of marketing campaigns designed to sell us sickness.” “You can trust your doctors,” agreed Dr. Breggin, “only to the degree that you can trust the drug companies who provide them with most of their drug information.”

Conferences

There are more than 300,000 scientific conferences and events sponsored by the industry each year. Many of them are hosted by the various professional societies which are partially or mostly funded by drug corporations.

During these meetings, “educational” material, including speaking sessions and literature, is given to the attendees. At least 60% (and in some cases 100%) of this material is based on research funded by drug corporations. In addition to the presentation material being produced mostly by the industry, almost all of the doctors who deliver the speeches at these conferences are consultants to at least one drug corporation.

For instance, at the 2005 APA conference in Atlanta Georgia, the list of psychiatrists scheduled to speak who disclosed that they were receiving payments from the industry, numbered in the hundreds. Some speakers were consulting for as many as 25 different corporations.

At some of these meetings, clusters of doctors wondering through the halls are reportedly met by pharmaceutical sales representatives who greet them with gifts and smiles. The halls themselves are filled with expensive artistic creations consisting of lights, sound, food, and electronic gizmos that announce the successes of the companies’ drugs. The doctors themselves sometimes become walking advertisements for drug corporations, with corporate logos looped around their necks.

Attendees receive free items at display booths if they express even a minimum of interest. Some allegedly crowd and push their way through to the booths in order to get the gifts. All gifts are marked with corporate or brand logos.

Some doctors carry multiple bags which they stuff with loot, including: notepads, coffee mugs, tiny fans, rubber models of various organs, plastic trinkets of all sorts, candy, samples of drugs, baseball caps, mouse pads, small flashlights, luggage tags, etc.

“People outside of medicine would be dazzled to watch some physicians interact with industry representatives at medical meetings,” observed Dr. Kassirer. At one meeting he attended, a pharmaceutical company was giving away an item the size of a book in an unmarked box. He witnessed physicians grabbing them in frenzy even though they had no idea what was inside. At another meeting he watched them repeatedly reach over and behind sales representatives to snag T-shirts when they couldn’t be handed out fast enough.

Peterson recognized the same behavior at a meeting she attended, where she witnessed physicians wandering through halls, stopping at each booth to pick up a few items and stuffing them into large shopping bags, which were filled with trinkets. In addition to these gifts, there’s always plenty of free food.

At some booths doctors can simply walk up and grab an item. However, the bigger gifts require that a questionnaire be filled out which allows the sponsoring corporation to obtain some of the doctor’s private information. The questionnaires themselves are advertisements in disguise.

And if a doctor doesn’t know the answer to a question, a helpful sales representative is always there to provide the correct answer (promotional plugin). After they have given their private information to a company, he or she is vigorously targeted for various promotions.

Journalist Ray Moynihan and policy researcher Alan Cassels attended the 2004 annual conference of the APA in New York City. They mentioned that the exhibit hall contained many booths run by sales representatives offering free gifts to psychiatrists. “Hundreds of doctors,” they explained, “are lining up at the stalls like eager kids at a carnival, filling out forms and entering their names into competitions in the hope of winning tiny trinkets.”

At this conference, companies paid about $2,000 for each 10x10 foot booth inside the colossal exhibit hall. They also sponsored 50 scientific sessions throughout the conference which lasted a week. Although the APA won’t confirm how much it charges the industry for these sessions, it’s reportedly tens of thousands of dollars each.

Some of the speaking sessions occur during meal times. On one day, at breakfast psychiatrists were educated about bipolar disorder at the Marriott Marquis Hotel, sponsored by Eli Lilly. GSK funded a lecture at the Grand Hyatt at lunchtime so they could learn about maternal depression. Then Pfizer provided a lecture on generalized anxiety disorder during a dinner at the Grand Ballroom of the Roosevelt.

The Industry’s Control of Research
Thought Leaders

The senior physicians who significantly influence their peers are called thought leaders in the industry. Some of them are identified by detailers and then trained by the industry. Thought leaders are used by drug corporations to perform a variety of functions: They conduct the research, write the CPGs, and publish articles in medical journals.

They also “educate” their colleagues at conferences. First, they’re given small speaking assignments, and if they’re successful they may end up earning thousands of dollars making presentations to their peers at events such as the APA’s yearly conference. Some Madison Avenue PR Firms have divisions that specialize in organizing these industry meetings. In addition, they train the industry’s leaders on how to speak. They create professional slide presentations and write literature. Frequently, they even write the speeches which the doctors deliver.

Thought leaders are a critical part of the industry. In addition to creating articles which appear in medical journals, these physician consultants may be recruited into a drug company’s advisory board or committee where they enter into patent and royalty agreements. Many of them hold positions at prestigious academic institutions while serving as consultants to the industry.

These leaders may be on the advisory boards and speaking panels of multiple drug corporations. Their lectures occur at hospitals, hotels, restaurants, medical meetings, and conferences. And their performance is tracked by measuring the prescribing habits of their peers that have been “educated.” According to Dr. Kassirer, such industry leaders have been heavily corrupted by greed due to an enormous infusion of cash.

Research/Schools

Up to three-quarters of the scientific research on prescription drugs is funded by the industry. Some of this occurs at academic institutions, which the industry has close ties with. The researchers who submit these articles are often physicians consulting with the drug companies whose products they are studying. These doctors gain prestige and an honorarium for their work.

These researchers receive not just grants for their articles but also a host of other financial arrangements, revealed the New England Journal of Medicine, which noted that many of them allow themselves “to be plied with expensive gifts and trips to luxurious settings.”

Some medical schools receive research equipment, materials, funds, and sponsored trips to medical meetings from drug corporations. The amount that drug corporations spend at these schools is said to be enormous. The industry reportedly has lots of control over the research conducted at these schools. And the research priorities are typically geared toward boosting drug company sales.

The results of these studies are distributed at over 300,000 conferences and events which are sponsored by the industry each year, as well as some of the world’s best medical journals. The Los Angeles Times remarked, “Conflicts of interest among university medical researchers have received wide attention in recent years.”

In their May 2005 article, Medical Journals are an Extension of the Marketing Arm of Pharmaceutical Companies, PloS Medicine mentioned that these articles frequently appear in major journals such as Annals of Internal Medicine, JAMA, Lancet, and New England Journal of Medicine. In March 2004, Dr. Richard Horton, editor of the Lancet commented, “Journals have devolved into information laundering operations for the pharmaceutical industry.”

Dr. Kassirer notes a study conducted in 1998 at the University of Toronto by Dr. Henry Stelfox and his colleagues who examined 70 articles regarding blood pressure medication. They contacted only the authors who had written favorably about certain prescription drugs to find that 96% of them had solid financial connections to drug corporations.

Even the peer review process, which medical publications must go through in order to maintain a high level of accuracy, has been systematically dismantled by the pharmaceutical industry, which it has accomplished by hiring the reviewers.

Ghostwriting

However, the situation appears to be more complex. In 2003 the UK Guardian revealed that ghostwriters in the pay of drug companies are now writing nearly half of the research articles that appear in some medical journals in order to promote prescription drugs. The articles are then affixed with an influential doctor’s name.

In addition to producing written material which is submitted to journals, they allegedly create speech material for physicians to deliver at professional conferences. “They, and the involvement of the pharmaceutical firms, are rarely revealed,” mentioned the Guardian.

The ghostwriters are medical writing experts employed by medical writing agencies, which specialize in producing “magical strategies” with the power to persuade. The articles, clinical trial reports, medicine reviews, and medical textbooks that they create consist of some scientific content, but are primarily intended to boost the sales of their clients’ drugs.

“The new controversy,” announced the New York Times in October of 1994, “focuses on the role of public relations firms and ghostwriters.” Most readers of medical journals, cautioned the Times, would be unaware that the articles had originated from authors paid by corporations.

Although there are reportedly dozens of medical writing agencies, some include: IntraMed, Axis Healthcare Communications, Excerpta Medica, Edelman Medical Communications, and Complete Healthcare Communications.

These agencies may charge up to $20,000 for a single article. The doctors themselves have been paid as much as $2,500 per article to serve as “author.” Some of the evidence linking the industry to the medical writing agencies includes internal documents that surfaced during lawsuits against companies such as Wyeth, Pfizer, and GlaxoSmithKline.

Other evidence comes from the ghostwriters themselves. Linda Logdberg, who had ghostwritten articles for over a decade, called it “marketing masquerading as science.” The Guardian interviewed former ghostwriters who confirmed that drug corporations pay the agencies to write articles favoring specific drugs, and then find a respected doctor to sign their name to it. They also exert much effort to conceal the fact that they’re ghostwriting papers on behalf of corporations.

When Dr. David Healy of the University of Wales was researching negative effects of antidepressants he was contacted by a drug manufacturer with an offer for assistance. They emailed him a ghostwritten favorable review of another drug which was to be presented at an upcoming conference. After he declined, he noticed that the exact same article had appeared in a psychiatric journal under another doctor’s name.

Dr. Troyen Brennan of the Harvard School of Public Health was offered $2,500 by Edelman Medical Communications to sign his name to an editorial that they wrote. Not only did he refuse, he described his experience in a September 1994 edition of the New England Journal of Medicine in an article called Buying Editorials.

In its September of 2009 article, Ghostwriting is Called Rife in Medical Journals, the New York Times reported that a significant number of articles that appeared in some of the world’s top medical journals in 2008 were written by ghostwriters financed by drug companies.

According to the Times and other sources, these ghostwritten articles are routinely circulated in the world’s best medical journals, including: New England Journal of Medicine, Journal of the American Medical Association, Lancet, PloS Medicine, Annals of Internal Medicine, British Medical Journal, and Nature Medicine.

Diagnostic Manuals

Professional societies are intricately involved in the creation of clinical practice guidelines (CPGs) as well as books, pamphlets, registries, websites, and other initiatives. They form panels of experts to create and update CPGs which are used by physicians all over the world to diagnose disorders.

The senior experts on these panels are also usually on the payroll of drug corporations. So, both the society and the individual members of the panels that write these guidelines are funded by the industry.

JAMA conducted a study of about 190 authors of CPGs between 1991 and 1999. In February of 2002 they published their results in a report entitled, Relationships Between Authors of Clinical Practice Guidelines and the Pharmaceutical Industry, where they revealed that 87% were in regular contact with an average of 10 different drug corporations.

They also discovered that 58% of them had financial ties to these corporations. “Increasing contact has been reported between physicians and the pharmaceutical industry,” they disclosed. “These interactions may be particularly relevant since CPGs are designed to influence the practice of a large number of physicians.”

A diagnostic tool called Prime-MD contains a 26-item checklist that allows any physician to diagnose a variety of mental disorders in as little as 8 minutes. Pfizer not only completely funded the diagnostic tool, it paid for the training of thousands of doctors in its use at multiple symposiums.

A questionnaire created by Pfizer and distributed by the health insurer Wellmark consisted of 9 questions which Wellmark required their physicians in Iowa to ask their patients visiting for such simple matters as an annual checkup.

They were told to give the quiz to patients that appeared to be tired, had many worries, didn’t get enough sleep, or had problems at work or home. The questionnaire allowed for the quick diagnosis of depression, which required treatment with antidepressants. It was intended for implementation across the country.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) put out by the APA is heavily funded by the industry. It is the most common source used for detecting mental disorders. For both the 1994 and 2000 editions, all of the panel experts who contributed to the diagnostic section pertaining to schizophrenia spectrum disorders were connected to drug corporations.

In addition to influencing the creation of CPGs, drug corporations have much control over the content of most psychiatric journals because the publishers rely on funds generated from drug company advertising.

“Ultimately, even medical and psychiatric textbooks are written by drug advocates,” observed Drs. Breggin and Cohen, in their book Your Dugs May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs. “In conclusion,” added JAMA, “there appears to be a high degree of interaction between authors of clinical practice guidelines and the pharmaceutical industry.”

Illness Creation

According to multiple researchers, drug companies have expanded their target-set to include the healthy in order to increase their profits. To do this, illnesses must be created. This practice is well-known among industry insiders. It’s called medicalization, disease-mongering, and condition branding by those in the industry. It uses a PRS formula adjusted for medical purposes to maximize corporate profit. Like the standard PRS formula, its basic tactics includes generating fear regarding existing medical conditions as well as the creation of new ones.

The famous Madison Avenue marketing guru Vince Parry has frequently worked with the industry to create new illnesses, and explained the process in his 2003 article, The Art of Branding a Condition, which appeared in an industry magazine called Medical Marketing and Media.

Parry described it this way: “The idea behind ‘condition branding’ is relatively simple: If you can define a particular condition and its associated symptoms in the minds of physicians and patients, you can also predicate the best treatment for that condition.”

Notice that Parry has suggested that an actual medical condition need not exist; it is only that one needs to be manufactured in the minds of physicians and their patients. According to Parry, the explosion of mental disorders in each new edition of the DSM is due to successful condition branding.

Condition branding, says Parry, uses a basic “problem/solution structure.” His particular method includes several tactics, two of which are notable. The first is what he describes as elevating the importance of an existing condition. The other is the development of a completely new condition.

As an example of the first tactic, Parry cites a marketing initiative by GlaxoSmithKline in the late 1980s. In order to boost the sales of their drug Zantac, GSK decided to target those experiencing heartburn. To do this, they elevated the medical importance of the condition by portraying it as a “disorder” with an underlying physiological cause. GSK also linked it to actual serious medical disorders, while they launched several educational and awareness raising campaigns. The result was a 65% increase in their sale of Zantac.

Parry then gives an example of how a new medical condition was created by Warner-Lambert in the 1920s in order to boost the sale of Listerine. Warner-Lambert knew that the idea of unpleasant breath wouldn’t motivate many people to purchase their product. So, they created an illness called halitosis and linked it to a variety of social misfortunes from divorce to lack of career advancement.

“Warner-Lambert found its answer,” commented Parry, “by creating awareness and anxiety around a serious-sounding medical condition.” Warner-Lambert increased its profit from $100,000 per year to about $4 million over a six year period because of its awareness raising campaign.

A frequent excuse used for launching these campaigns by drug corporations and their PR firms is that millions are suffering in silence. Anyone who questions their motives is said to be questioning the patient’s suffering.

In her book, Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick, Lynn Payer describes the practice of taking a normal function and implying that there’s something wrong with it as a fear-mongering tactic. This is done by the pharmaceutical industry for life’s common experiences or situations such as insomnia, anxiety, menopause, emotional isolation, job frustration, angry or hostile feelings, obesity, and even shortness.

Although there are many, many examples of this, Petersen cites a couple more cases where condition branding has been used, including how panic disorder was relatively unknown until Upjohn began marketing Xanax in the 1970s.

And how, in 2000, women began to learn that they were suffering from premenstrual dysphoric (PMDD) after Eli Lilly repackaged their antidepressant Prozac in a different capsule, renamed it Sarafem, and marketed it to treat PMDD.

GSK, the manufacturer of the antidepressant Paxil, turned what was considered a rare psychiatric condition into a major epidemic called social anxiety disorder. According to GSK, this affected one out of eight Americans at one time.

To do this, GSK used a Madison Avenue PR firm called Cohn & Wolfe which created the appearance of a grassroots movement to raise awareness about this neglected disorder.1 Cohn and Wolfe’s aggressive media outreach included press kits, video releases, and a network of spokespeople. They also used a variety of people from patient advocacy groups to perform patient testimonials.

Awareness raising campaigns benefit greatly from the use of medical experts, so Cohn and Wolfe used University of California psychiatrist Dr. Murray Stein, who assisted in the corporate-funded trials. Dr. Stein has allegedly worked for at least 15 other drug corporations as a consultant. GSK’s awareness raising campaign made Paxil the world’s top-selling antidepressant at $3 billion a year.

An Expanded Target Set

Moynihan and Cassels mention a 2003 Reuters Business Insight report entitled, Healthcare: The Lifestyle Drugs Outlook to 2008, which was directed at drug company executives.

The report advocated the creation of “new disease markets” to increase prescription drug sales by billions. This would be accomplished by making people think that natural processes were medical conditions to be treated by prescription drugs.

“We now have clinical names and treatment guidelines for unhappiness, loneliness, and shyness, as if it were no longer okay to feel the emotions that make a life,” explained Petersen. “The ups and downs of life have become mental disorders,” wrote Moynihan and Cassels, “common complaints are transformed into frightening conditions, and more and more ordinary people are turned into patients.” In addition to targeting healthy adults, the industry has expanded its scope to include healthy children.

According to Petersen’s sources, by 2004 about 10% of all ten-year old boys were on Ritalin. A report which she mentions by Medco Health Solutions revealed that within a period of a few years a 369% increase occurred in the spending of psychiatric medication on children not yet old enough for kindergarten.

“The National Institute of Mental Health (NIHM) and pharmaceutical companies have been placing increasing emphasis on marketing psychiatric drugs to children,” warned Breggin and Cohen.2 They then cite the results of an international survey done by the APA on a grant from Bristol-Meyers Squibb Company. The report, presented at the 1998 annual meeting of the APA in Toronto Canada, suggested “aggressive treatment in childhood and adolescence.”

However, rather than focusing on parents who might consider medicating their children, drug corporations are now promoting them directly to kids. Data collection initiatives using animated TV commercials during airings of Sesame Street have been used. Others have appeared in Sesame Street Magazine, and with website questionnaires.

Their promotional campaigns include propaganda delivered through storybooks, coloring books, video games, and websites with games and animated stories. Disney-like characters with drug labels on their costumes have been created.

Toys bearing the labels of drugs are being used. They include superhero dolls, stuffed animals, and hand puppets. All of this merchandise is clearly marked with drug brand names so children will relate to them as toddlers and begin asking their parents for them by their brand names as they get older.

Toy needles have even been designed so that they can practice injecting themselves. Drug promotional campaigns using live animals at children’s parties have been launched. Pfizer has paid the Children’s Television Workshop to show its muppets going to the doctors, etc, etc.

As part a massive public relations initiative, which includes research studies, publications, and speeches, the industry is now using its thought leaders to rigorously promote powerful prescription drugs for children. Chief of the Program in Pediatric Psychopharmacology at Massachusetts General Hospital, world renowned Harvard psychiatrist Dr. Joseph Biederman, is one of the most influential researchers in child psychiatry.

Between 1994 and 2003 he and his colleagues conducted studies financed by drug corporations which suggested there was a major underdiagnosis of bipolar disorder in children that could be treated with powerful antipsychotic drugs originally developed to treat adult schizophrenia.

In June of 2008 the New York Times reported that Dr. Biederman and his colleagues had been promoting the aggressive diagnosis and drug treatment of childhood bipolar disorder, which is a mood disorder that was once confined mostly to adults. Dr. Biederman’s studies are responsible for a 40-fold increase in the diagnosis of pediatric bipolar disorder. “As a result, pediatric bipolar diagnoses and antipsychotic drug use in children have soared,” revealed the Times. Dr. Biederman received at least $1.5 million in consulting fees from 15 different pharmaceutical companies between 2000 and 2007.

Professor of Psychiatry and Human Behavior at Brown University, and chairman of the psychiatry department at the Alpert Medical School, Dr. Martin Keller, released a study in 2001 entitled Study 329, in which he suggested that GSK’s antidepressant Paxil should be given to children. In his article, for which he made huge sums of money, Dr. Keller allegedly suppressed important information linking the drug to suicidal tendencies.

Dr. Keller made about $840,000 in 1999 alone from drug corporations such as Pfizer, Bristol-Myers Squibb, Wyeth-Ayerst, and Eli Lilly while serving as chief of the psychiatry department at Brown University. He has promoted the use of prescription drugs in a variety of medical journals such as Biological Psychiatry, for which he’s made at least $93,000.

Co-author of Study 329, Dr. Karen Wagner is a professor at University of Texas Medical Branch at Galveston. She has worked on NIH-funded studies on the use of GSK’s Paxil to treat teenage depression, and has received about $150,000 from GSK. She has also conducted dozens of corporate-sponsored studies favoring the use of antidepressants for children.

In March of 2009, The Boston Globe reported that a complaint filed by federal prosecutors in the US District Court in Boston revealed that Dr. Jeffrey Bostic, the Director of School Psychiatry at Massachusetts General Hospital, heavily marketed antidepressants for children on behalf of a corporation called Forest Laboratories in New York.

Between 2000 and 2006 Dr. Bostic gave 350 presentations on the pediatric use of Celexa and Lexapro in 28 states while he made over $750,000. Forest Laboratories even paid Dr. Bostic to visit physicians in their offices in order to ease their concerns about prescribing these powerful drugs to children.

Head of the Department of Psychiatry, at the University of Minnesota Medical School, Minneapolis, Dr. Charles Schulz has had financial connections to AstraZeneca, Eli Lilly, Abbott Laboratories, and Janssen. He has conducted seminars funded by AstraZeneca to promote the use of their antipsychotic drug Seroquel on children.

In May of 2007 the New York Times announced that increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics. These drugs include Seroquel, Zyprexa, Abilify, Risperdal, and Geodon. “Drug makers,” they said, “underwrite decision makers at every level of care. They pay doctors who prescribe and recommend drugs, teach about the underlying diseases, perform studies and write guidelines.”

The sudden explosion of pediatric bipolar diagnosis, said the Times, has caused a boost in sales of these new prescription drugs. The impetus for this explosion was another research study done by a child psychiatrist at the University of Cincinnati, Dr. Melissa DelBello, with funding from AstraZeneca.

Dr. DelBello led a research team that tracked the behavior of 30 adolescents diagnosed with bipolar disorder for a month and a half. In 2002 she published the results which concluded that AstraZeneca’s drug Seroquel performed well.

Her report was reviewed favorably by a panel of prominent experts in 2005, resulting in guidelines being published in The Journal of the American Academy of Child and Adolescent Psychiatry. Three of the four panel experts that reviewed Dr. DelBello’s report served as consultants to drug corporations. One was Dr. Robert A. Kowatch, a psychiatrist at Cincinnati Children’s Hospital. Both Dr. DelBello and Dr. Kowatch have been hired as spokespeople for AstraZeneca.

The scenario unfolding, according to these sources, is that the industry will continue to aggressively target the entire population until most people are convinced that they need at least one pill a day for the rest of their lives. “Because as Wall Street knows well,” remarked Moynihan and Cassels, “there’s a lot of money to be made telling healthy people they’re sick.”

The pharmaceutical industry is, and has been for years, the most profitable industry in the US. In 2006 it was a $643 billion dollar industry, globally. $289 billion of this total originated from prescription drug sales in the US. This was an increase from the $200 billion it spent in 2005, which was a significant increase from $40 billion spent in 1990, which rose from $12 billion in 1980.

“A basic goal of the pharmaceutical marketers,” Petersen explained, “was to create an enthusiasm among the public for lifelong medication use.” Drs. Breggin and Cohen observed: “Few if any people realize that they are being subjected to one of the most successful public relations campaigns in history.” The entire population is now being literally attacked by a high-powered selling campaign for psychiatric drugs, conducted by this complex through its various fronts. They are targeting everyone!

The industry will obviously continue using PRS, which Parry says, has been brought to new levels of sophistication recently. “Today,” says Parry, “the seeds must be sown in a complex landscape of audiences involving pharmaceutical companies, external thought leaders, support groups and consumers; and the effort must be coordinated with multiple communications agencies in the fields of branding, advertising, education and public relations.”

Summary

The control which drug corporations have over the medical field is extensive. Drug corporations are able to conduct the research, write the reports of the research, and control the peer review process of articles that appear in the world’s best medical journals. They write the clinical practice guidelines which doctors use for diagnosis.

And they not only expand the symptoms of existing illnesses, they create new ones which appear in the clinical practice guidelines that they write. They control much of the educational process that most physicians will undergo, with literature, as well as by influencing the medical schools and universities themselves with funding.

Drug corporations influence or outright control professional societies and advocacy groups such as the APA, AMA, MHA, CHADD, and NAMI, as well as federal entities such as the US Congress, FDA and NIH. Their influence extends to insurance providers and medical centers.

Dr. Breggin refers to these groups collectively as the psychopharmaceutical complex. In most cases its control reaches down to the level of the individual physician, which includes the medical leaders of governmental institutions and professional societies who have been compromised by greed. The corruption is not simply rampant, it is highly organized from the top, at which sits the pharmaceutical industry.

Sources

1. An interesting name, Cohn & Wolfe. Or is it conning wolf?

2. Children are increasingly being prescribed stimulants for fake mental illnesses such as ADHD. The solution for this disorder includes giving them brain-damaging drugs such as Ritalin. When stimulants fail they're given more powerful adult antipsychotics which cause a literal chemical lobotomy. See Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, by Melody Petersen. Also see Medication Madness: A Psychiatrist Exposes the Dangers of Mood-Altering Medications by Dr. Peter R. Breggin. However, other than greed, there appears to be another factor which is motivating the financial elite to target healthy children. As I'll describe in my next book, there is a pattern emerging regarding the profiles of the children being singled out and medicated. Many of them are highly intelligent, middle class males with leadership traits.