[Paleopsych] How Big Pharma Blew It

[Steve Hovland]

http://www.chiefexecutive.net/depts/pharmaceuticals/204.htm
Bad choices and PR gaffes have finally caught up with the drug industry.
BY FRAN HAWTHORNE
For years now, Big Oil, tobacco and HMOs have pretty much held a monopoly 
in consumer loathing. But no longer: According to a recent Harris Poll, 
pharmaceutical companies have tied the big bad three as the industry that 
consumers love to hate the most.
In fact, opposition is coming from all sides. Politicians from both major 
parties regularly denounce the drug makers for their prices, their 
marketing and for blocking Grandma from buying inexpensive medication from 
Canada. New York State Attorney General Eliot Spitzer this summer charged 
GlaxoSmithKline, the second-largest drug company in the world, with fraud 
for not revealing the negative results of clinical trials that tested 
antidepressants on children.
Dozens of states have sued or investigated drug companies over their 
pricing tactics. In the space of just a year and a half, at least six books 
critical of the industry have been published, with titles like The Truth 
About the Drug Companies and The Big Fix. "You take Pfizer, you take Merck, 
you take Bristol-Myers, you take GlaxoSmith," says Larry Bossidy, former 
CEO of Honeywell and author of the new book Confronting Reality. "All of 
them face the same challenges. They're all looking down the same gun 
barrel."
>From Indiana to New Jersey to Basel, Switzerland, CEOs of Big Pharma 
scratch their heads at the outpouring of anger. How did an industry that 
makes Gleevec as a treatment for cancer, Fosamax for osteoporosis and 
Lipitor for cholesterol-an industry whose products save people's lives-come 
to be so reviled? And what, if anything, can they do now to change that 
negative image? The giant drug makers and small biotechs, as well as 
consultants, economists and consumer advocates, point to causes that range 
from lousy PR to nasty battles with manufacturers of low-cost generic drugs 
to the flawed basic structure of health care in the United States. The 
biggest single point of protest is prescription drug prices, which have 
been soaring at far faster rates than the general cost of living. To some 
degree, the industry's dilemma is the inevitable side effect of being a 
big, profitable business. But to a larger degree, the wounds are 
self-inflicted. "What the public is telling us is, 'We love the innovation 
that you come up with, but we can't afford it,'" says Sidney Taurel, 
chairman, president and CEO of Eli Lilly.
>From the other side of the divide, Dee Mahan, senior policy analyst at the 
Washington-based consumer group Families USA, puts it this way: "It's not 
like buying a Lexus-it's not something where you have a choice. People get 
angry because this is something that is critical that they need, and 
companies are raising the prices so much."
Most people date the current problems to the early 1990s, when President 
Bill Clinton's health care reform plan rode a tide of public concern about 
rising costs. At first, HMOs bore the brunt, but after they loosened their 
coverage rules, the angry eye turned to drug companies.
Some of that is convenience. These companies were obvious targets because 
they were big, they comprised one of the nation's most profitable 
industries, and they were powerful players in Washington. And just around 
that time, a flurry of breakthrough drugs came to market, like Mevacor for 
elevated cholesterol and Prozac for depression, and new drugs are always 
pricier than older ones with generic competition. "It's politically easier 
to point a finger at the small number of big pharmaceutical companies than 
at hospitals and doctors," complains Ben Hohn, a New York-based consultant 
at The Monitor Group, who specializes in biopharmaceuticals. "People have a 
personal relationship with the doctor, and they tend to associate the 
doctor with the hospital."
Daniel Vasella, CEO of the Swiss drug giant Novartis, notes that "it became 
pretty obvious in the late '90s that the industry had a problem." A decade 
earlier, he recalls, people reacted with sympathy when he told them he 
worked for a drug company. "Today, the reaction is generally cold." Vasella 
and other industry defenders say a knowledge gap among consumers is 
partially to blame for their troubles. The economics of drug pricing and 
the relative benefits, they say, are intrinsically difficult to explain to 
the general public.
"People don't realize the tremendous risks," says Kenneth I. Moch, 
president and CEO of Alteon, a New Jersey biotech company that specializes 
in cardiovascular disease, diabetes and aging. "The only way to attract 
investors and capital is to have high rewards." Based largely on 
controversial studies by Tufts University's Center for the Study of Drug 
Development, the industry claims it costs over $800 million and takes at 
least 12 years, on average, to come up with a new drug.
Shot in the Foot
Still, the pharmaceutical makers can hardly claim to be innocent victims. 
Even some industry stalwarts cringe at the record:
They filed multiple lawsuits, sought questionable patent extensions and 
made outright payoffs to generic companies in order to maintain their 
monopolies on expensive blockbuster drugs like AstraZeneca's Prilosec for 
heartburn and Bristol-Myers Squibb's Glucophage for diabetes.

They plied doctors with fancy dinners, Super Bowl tickets and exotic 
vacations to persuade them to prescribe particular drugs-sometimes going so 
far that they broke the law.

As AIDS and HIV spread across poverty-stricken Africa, they refused to 
lower the prices of their expensive medications, claiming they didn't want 
to set a precedent by ceding any intellectual property rights. When the 
companies finally gave in to public pressure, they did it in baby steps and 
had to be tugged again and again. "The HIV story is not a pleasant one," 
Roy Vagelos, the former CEO of Merck, said in a 2002 interview. "Not coming 
up with a [discount or donation] program earlier was very damaging to 
[Merck's] reputation."
After the Food and Drug Administration opened the door to pharmaceutical 
advertising on TV in 1997, the ad dollars poured in. The industry now 
spends some $3.8 billion on direct-to-consumer advertising that is almost 
indistinguishable from commercials for Diet Coke or Tide. The companies 
defend this as educating the public. But Mahan of Families USA says, "There 
is just too much. People ask, 'This is where the R&D money is going to?'"

James Love, director of the Consumer Project on Technology, another 
advocacy group in Washington, points to another problem with TV 
commercials: "[The companies] lose the aura of the scientific organization. 
They come across as selling soap."
On top of all that, baby boomers were starting to hit their 50s in the late 
1990s, an age when prescription use rises dramatically. And boomers are a 
lot less likely than their parents to meekly swallow their doctors' 
advice-or expensive medicine.
As the bad headlines and bad feelings piled up, says Ira S. Loss, executive 
vice president of the stock-market research firm Washington Analysis, "I 
think the leadership was very slow to recognize the severity of the 
problem." For an industry famous for its political clout-it usually has 
more Washington lobbyists than there are members of Congress-Big Pharma was 
politically tone-deaf to the PR disaster it was incurring by opposing a 
prescription drug benefit in Medicare for many years and blocking the 
purchase of low-cost drugs from Canada. "We were concerned more with 
explaining our point of view to opinion leaders and politicians than to the 
general public," Lilly's Taurel concedes. "That may have helped worsen our 
image."
Self-Analysis: A Good Start
Boyd Clarke, a former marketing executive at Merck and now CEO of Neose 
Technologies, a Philadelphia-area biotech firm, muses: "I sometimes wonder 
whether Pharma has not gotten itself in a bad position by being so 
identified with the Republican Party that there is a great deal of 
difficulty in getting its message out in a nonpartisan context."
Now the drug makers have started to catch on and have attempted to 
introduce change. Executives like Taurel, Vagelos and Pfizer CEO Henry 
McKinnell have been speaking out about some of the issues behind the 
industry's lousy image. The Pharmaceutical Research and Manufacturers of 
America, the major trade group, in 2002 adopted tighter restrictions on 
marketing to doctors (though arguably these are still often ignored). After 
Spitzer's lawsuit, Glaxo, Lilly and Merck announced they would make more of 
their trial results publicly available. Many people also praise 
Bristol-Myers Squibb for its public service ads featuring cyclist and 
cancer survivor Lance Armstrong talking about the importance of 
pharmaceutical R&D. And this fall Pfizer launched an innovative program to 
sell drugs at deep discounts to the uninsured and working poor.
But with prices still the highest in the world, TV ads blaring and patients 
complaining, Big Pharma obviously has more work to do. Merck's recent 
recall of its blockbuster arthritis drug Vioxx, for serious cardiovascular 
side effects, has only added to the public cynicism, because the company 
had spent the prior three years pooh-poohing published studies that hinted 
at exactly those cardiovascular problems and allegedly trying to silence 
scientists who warned of the dangers.
The industry's most common advice to itself is to do a better job of making 
the points about risk, reward and innovation that it claims the public 
doesn't understand. Robert Essner, CEO of Wyeth, declared in a speech to 
the industry last spring that "too often our messages are aimed only at the 
head and are too easy to brush aside. We are most effective when we also 
aim our messages at the heart." Actually, while CEOs may prefer the 
self-image of being too fact-oriented, most critics say the real problem is 
the opposite: The industry has to do more to get its message out with hard 
facts, rather than showcasing sexy athletes who use Viagra.
Advertisements should have charts showing how much the companies spend on 
R&D and marketing and how much they make in profit, suggests industry 
veteran Robert Ehrlich. As the marketing executive who launched the 
blockbuster cholesterol pill Lipitor at Warner-Lambert and who now runs a 
direct-to-consumer consulting company, Ehrlich knows how to craft an image 
campaign. He also urges companies to air more public service announcements 
about medical conditions and wellness in general, rather than just pitching 
particular brands.
Some experts say CEOs should be out there personally delivering the 
message. "It implies the importance the corporation attaches to the issue," 
explains William W. McCutchen Jr., deputy chairman of the management 
department at Baruch College's Zicklin School of Business in New York City. 
That would be a historic change for the industry. While hip, young, 
high-tech chief executives are all over the media, "there were not as many 
celebrity CEOs in pharmaceuticals," says Alteon's Kenneth Moch. "[The 
industry] was less oriented to consumer marketing, more intellectual and 
scientific."
Politically, too, Big Pharma must change its M.O. It needs to choose its 
battles-and when it can't win, it should bow out gracefully, not 
grudgingly. The war against reimportation is already lost. So are the most 
egregious attempts to stretch out patents.
To skeptics, those suggestions are mere window-dressing. Just ask Abbey 
Meyers, president of the National Organization for Rare Disorders, an 
advocacy group for patients with diseases that affect few people, what Big 
Pharma ought to do, and she has one answer: "Lower your prices." Even 
marketer Ehrlich offers that "a bold strategy would be, 'Let's cut our 
prices 30 percent.'" Not only would that solve the image problem, he 
contends, but it would also increase sales and possibly head off government 
price controls.
Is True Reform Possible?
If an across-the-board price cut seems too bold, then Ehrlich and others 
recommend that the manufacturers broaden their discount programs, which 
generally have been available only to the elderly poor. They could 
publicize the programs better, perhaps fatten the discounts, loosen 
eligibility rules as Pfizer did and set up a coordinated Web site. (A pilot 
site is being tried in three states.)
The problems with health care costs in the U.S. go beyond the bill at the 
neighborhood pharmacy. "There's no way the pharmaceutical industry, as 10 
to 12 percent of total health care spending, can solve the problem," says 
consultant Ben Hohn. For example, a key issue in this year's presidential 
election was expanding coverage to the approximately 45 million Americans 
without health insurance. Big Pharma CEOs could speak out about the issue 
and use all those Washington lobbyists to urge Congress to pass health care 
reform. The industry has a business stake in this debate, Hohn points out, 
because people with insurance can better afford to buy the medicines they 
need.
A growing number of thinkers believe it's simply too late for the industry 
to reform. There's a fair amount of discussion about radically splitting 
the whole development process, with biotechs, universities and independent 
labs doing the R&D and a shrunken Big Pharma handling only manufacturing 
and marketing. At the least, the giants are being forced to rely more and 
more on biotechs to churn out genomics-based drugs targeted to smaller 
markets. Meanwhile, almost everyone expects more government regulation. The 
conventional wisdom is that inevitably, despite President Bush's 
opposition, the new Medicare drug law will be amended to allow the 
government to negotiate prices, and that will lead to overall price 
controls.
Of course, the ultimate solution is for the pharmaceutical companies to do 
what they claim they want to do: discover important new drugs-real medical 
innovations, not copycat drugs or treatments for lifestyle problems. "We 
should not be focusing on our reputations per se," says Vasella of 
Novartis. "The best thing we can do as an industry is to focus on our 
mission, which is to help cure patients and ease suffering." Indeed, if 
drug companies unveiled a more effective treatment for Alzheimer's disease 
or the holy grail of medicine-a cure for any kind of cancer-that could well 
be the best medicine for the industry's ailing image.
Fran Hawthorne is the author of The Merck Druggernaut (John Wiley & Sons) 
and the forthcoming Inside the FDA (Wiley).