In Documents on Pain Drug, Signs of Doubt and Deception (click for full article)
A research director for Pfizer was positively buoyant after reading that an important medical conference had just featured a study claiming that the new arthritis drug Celebrex was safer on the stomach than more established drugs. “They swallowed our story, hook, line and sinker,” he wrote in an e-mail to a colleague.
There is a school of thought in medicine that goes “You don’t want to be the first or last to jump on the bandwagon of new dugs or treatments”. This is in large part due, not to the original reason the statement was offered, but to deception of the part of researchers and their employers or sponsors, i.e. BigPharma.
When I first learned this “rule” in pharmacy college, the concern was speculation about the possibility of unknown or less common problems that would only surface after the use of the drug or treatment became more widespread.
Sure we knew that the drug representatives frequenting physician offices would downplay any such possibilities and put the best light on their products, but we did not think that data was fudged. Cherry-picked a bit sure, but not outright deceptive. We thought drug reps purposely lived in the safe harbor of gray data that was open to some “interpretation” and walked the line allowing a walk back if overtly contradictory evidence surfaced.
The “new” reality is different however. I say “new” only because the reality of deceptive corporate policy as part of “business as usual” has only recently been accepted. IT has likely been this way forever. Drug companies spend huge sums developing and testing new drugs. They want a return on that investment.
In this case, Pfizer was faced with the choice of being honest and losing any advantage the drug might enjoy in the marketplace versus lying and enjoying dominance in a huge market.
I personally came to terms with this overt dishonesty fairly early in my career as a physician.During pharmacy school, I learned that pharmacists have much more education on drugs than physicians, by a wide margin. In the real world, most physicians get the bulk of their education about the evolving drug market from drug reps, not independent legitimate educational sources. (New drugs are released at a rate of almost 1 per week.)
Once in practice, the stream of drug reps pushing their wears is never ending. Their “educational sessions” always came with freebies, food, gifts, outings etc. Even free starters packs of drugs for patients to get them hooked on the most expensive version of what was out there.Visits to my office were always a bit challenging to the reps as I critically reviewed their references and challenged their conclusions. The success I had over the years in shooting down the materials presented cemented in my mind the new reality that I speak of. Drug Rep visits were a rehearsed dog-and-pony show, which had no ethical boundaries in its preparation. Many of the drug reps were much too unsophisticated to even know they were speaking garbage. Many were nurses who have even less real pharmacology background. And virtually no experience in scientific review of study methodologies and critique. The companies provided a script. They learned it, assumed they were given honest data, representative studies, and legitimate conclusions to present. BUT IT JUST WAS NOT TRUE.
In this case, they were promoting a drug for one of America’s largest markets, arthritic pain, without the very serious known side-effects of stomach bleeding and ulcers. All of its competitors in that market had that downside. This was obviously a huge step forward that potentially offered real benefits to patients. It was promoted that way. And physicians believed it and in many practices literally stopped prescribing all competitors. What a coup. Just one problem, it was all a lie, and they knew it. As the article states “They swallowed our story, hook, line and sinker,” the head researcher wrote in an e-mail to a colleague.
The truth was that Celebrex was no better at protecting the stomach from serious complications than other drugs. It was just a new, very expensive option, still under patent, with no benefit over older dirt cheap drugs like ibuprofen. Oh, and it also is associated with increased risk of cardiovascular death and they sort of knew that too. It took years for that part of the story to emerge.