Pharma executives "have shown less interest in medicines like antibiotics that actually cure disease than in those that only treat symptoms," writes Melody Petersen, author of Our Daily Meds. "Most blockbusters are pills for conditions such as anxiety, high cholesterol or constipation that must be taken daily, often for months or years. They are designed for rich Americans who can afford to buy them." Nor are medicines for tropical diseases like malaria, which kills a child every 30 seconds, a priority, notes Petersen. They also lack ka-ching.
Since direct-to-consumer drug advertising debuted in the late 1990s, the number of people on prescription drugs -- especially prescription drugs for life -- has ballooned. Between 2001 to 2007 the percentage of adults and children on one or more prescriptions for chronic conditions rose by more than 12 million, reports the Associated Press and 25 percent of US children now take a medication for a chronic condition. Seven percent of kids take two or more daily drugs. Who says advertising doesn't work?
Of the top-selling drugs in 2011, led by Lipitor, Nexium, Plavix, Advair Diskus, Abilify, Seroquel, Singulair and Crestor, none is taken occasionally, or "as needed" and the treatment goal is never to get off the drug, like an antibiotic. Why would Pharma deal itself out of the game?
There are two ways Pharma hooks the US public on prescriptions for life. First, prescriptions that used to be taken as needed for pain, anxiety, GERD (gastroesophageal reflux), asthma, mood problems, migraines and even erectile dysfunction, gout and retroviruses (in some cases) are now full-time medicines. Instead of having a bad day or heartburn, you have a disease like anxiety or GERD which calls for full pharmaceutical artillery. Instead of having body pain to be treated transiently, you are put on an antidepressant like Cymbalta or seizure drug like Lyrica or Neurontin indefinitely.
Secondly, many of the top-selling drugs today are to prevent chronic conditions like high cholesterol, high blood pressure and osteoporosis that people are said to be "at risk" for. Needless to say, in both cases, people never know if the drugs are working or whether they would have had symptoms without them. This creates a loyal customer who is afraid to quit a prescription because it might be working. And why should they quit anyway when a third party is probably paying?
Here are some drugs -- not all -- that are marketed for perpetuity.
1. ADHD and Drugs for Pediatric 'Psychopathologies'
Thanks to Pharma's "diagnose early" and screening campaigns, millions of children are treated with stimulants for ADHD and antipsychotics for bipolar disorder and assorted conduct, oppositional defiant, development disorders and "spectrums" today. No wonder Michael Bandick, brand manager for Eli Lilly's popular antipsychotic Zyprexa, called it "the molecule that keeps on giving" at a national sales meeting.
But giving kids daily drugs creates two problems. First, parents will never know if their kids would have outgrown their conditions, and second, it's unlikely they'll ever get "clean." In fact, Pharma marketers worry about the revenue threat of kids going off their meds when they leave home and even run an ad campaigns in college newspapers to keep them on. One ad shows the lead singer of Maroon 5, declaring, "I remember being the kid with ADHD. Truth is, I still have it." The ad's tag line reads, "It's Your ADHD. Own It."
2. Hormone Replacement Therapy
When the popular HRT pill Prempro was launched by Wyeth, now Pfizer, in the 1980s, then-CEO Bob Essner told sales associates, “We can make real the full promise of HRT to create in the near future a world where the majority of women will start HRT at menopause and continue on it for the rest of their lives,” reports Philadelphia magazine. The scheme of treating estrogen "deficiency" for 30 or 40 years worked until 2002 when HRT was found to cause breast cancer, heart attacks, strokes, blood clots and dementia. They were some of the conditions it was supposed to prevent. Oops. But Pharma has not abandoned the billion-dollar franchise and news about estrogen benefits is creeping back into the news, predicated on the public's short memory. People don't lose hormones because they age; they age because they lose hormones, say Pharma hormone sellers. Even men now "suffer from" testosterone deficiencies or Low T.
3. Happy Pills
Pharma's success in convincing people with anxiety or the "blues" that they need an antidepressant was a Wall Street coup. Instead of taking the occasional Xanax, people agreed to alter their entire body chemistry with a drug they took for months, years or decades.
But as antidepressants fall in popularity, because of their many side effects, including alarming "discontinuation symptoms" when people try to stop, WebMD is conducting damage control to keep people on them. Don’t believe that antidepressants turn “you into a zombie,” make you gain weight, ruin your sex life, make you "forget your problems rather than dealing with them" or cost too much, says the huge pro-pill Web site in one article. Depression is linked to heart disease, obesity, diabetes, Alzheimer’s and cancer says a second WebMD article. Stay on your meds.
4. Proton Pump Inhibitors (PPIs)
Some say gastroesophageal reflux disease (GERD) is just lowly "heartburn" whipped up by Pharma into a profitable disease. But over 110 million prescriptions were written for proton pump inhibitors (PPIs) like Nexium and Prevacid in 2009, making it the third most prescribed class of drugs. Long-term use of PPIs increases the risk of hip, wrist and spine fractures, the FDA warns and the drugs can cause potentially lethal C. difficile-caused diarrhea and community-acquired pneumonia says national health advocacy group, Public Citizen. But Pharma has a different message. GERD can lead to esophageal inflammation, scar tissue and cancer, if untreated, it tells patients and symptoms won't go away on their own. No wonder doctors call PPIs "Purple Crack."
The best-selling statin drugs like Lipitor and Crestor that lower their cholesterol risks are pretty much the definition of "lifer medications," taken in perpetuity. Who would dare to go off of them and risk cardiovascular events?
One patient on a cholesterol drug site writes that despite feeling "miserable" on statins, "What do you do? Go off the statins and let your arteries clog up?" But medical professionals say it is not safe to stay on statins indefinitely. Patients are at risk of liver dysfunction, acute kidney failure, cataracts and muscle damage known as myopathy, reports British Medical Journal. And statins can also cause memory loss and increase the risk of developing of Type 2 diabetes and muscle damage, FDA warns.
Still the appeal of a drug that lowers the risk of cardiovascular events without a change in diet or lifestyle made Lipitor the top-selling drug in the world, until recently, when its patent expired. Statins are now prescribed for kids, for the same reason.
6. Asthma-Control Medicines
Like ADHD and "pediatric psychopathology" drugs, Pharma conducts aggressive early treatment campaigns for asthma drugs, recommending that children as young as one year be treated when "symptoms" first emerge. ("Before they go away,” says one cynical doctor.)
It has also marketed daily asthma "control" medicines like Advair and Symbicort so aggressively (prescription drugs added onto patients' regular asthma medicine -- ka-ching) that nearly two-thirds of the nation's millions of asthma sufferers take them. Despite the expense of adding an additional drug to rescue inhalers or inhaled corticosteroids when asthma is a lifelong disease, there are no clinical benefits to the upsell, says the research institute of Medco, the nation's largest pharmacy benefit manager. Neither trips to the ER or hospitalizations are reduced with control drugs. And there's another mark against the daily drugs that don't work: they may make asthma worse says some published reports.
Martha Rosenberg frequently writes about the impact of the pharmaceutical, food and gun industries on public health. Her work has appeared in the Boston Globe, San Francisco Chronicle, Chicago Tribune and other outlets.