Trump’s Plan to Put Drug Prices in TV Ads Is Just Another Win for Big Pharma
For more than 20 years, Berkeley-based attorney Don Arbor has successfully sued pharmaceutical companies for failure to warn consumers about defects in their drugs. Arbor said the drug companies manipulate the public and doctors to make big money. He recently spoke to the Independent Media Institute’s Steven Rosenfeld about those tactics, President Trump’s purported reforms and Arbor’s second career as a political songwriter.
Steven Rosenfeld: Let’s start by contextualizing some recent news based on your legal career. What do you make of President Trump’s latest statements that he is going to make the industry lower their prices and be more transparent?
Don Arbor: I don’t think that he knows what he’s talking about and I don’t think that he will do what he said; that would be the two-sentence summary. The pharmaceutical manufacturers have a large and powerful lobby that affects what gets through Congress. They are very much invested in the profits that they reap from selling pharmaceuticals in the United States at prices that are much higher than anyone else in the world. So the idea that Trump, who is basically not very politically savvy and not likely to have the skills even if he had the motivation to actually make prices lower, [will anything helpful] makes me very doubtful.
SR: One of Trump’s proposals is putting drug prices on television ads. Can you just break down why this is very slippery?
DA: To me, the slippery part is drugs being advertised on television at all. That’s called direct to consumer advertising. It is very effective and a very bad influence on consumers and the society as a whole.
Other countries do not have direct to consumer advertising. In fact, I don’t think the U.S. had it until relatively recently, probably 20 years or so ago. So direct to consumer advertising is a new phenomenon and it’s incredibly effective. In one of the cases I worked on, I read internal [company] documents that attested to how effective it was by the return on investment, which was basically that for a $60 million investment in advertising, the company reaped $195 million in profit, or over 3 to 1 return. They also did market research of the doctors, so that when you see on television, “ask your doctor if such and such drug is right for you,” the answer will almost will always be a yes, it’s right for you. That’s from doctors whose patients ask them because the doctors just want to get along with their patients, and so what they found was that 90 percent of the doctors who were asked by their patients to recommend this particular drug did so.
So you’re getting to another level about whether there should be prices in ads on TV. There shouldn’t be ads on TV for pharmaceuticals. That’s not a subject that people should be pitched, about what drug is right for them, because it’s all about how many pills they can sell and how much money they can make and not necessarily what’s good for the patient.
SR: Do you see what’s happening with TV advertising moving to the internet?
DA: I haven’t given that much thought. I don’t see why it wouldn’t move to the internet. I don’t know what legal restrictions there are about advertising drugs on the internet or whether if there were such restrictions, whether they would be adhered to; I don’t see that there’s any better reason to have internet advertising of pharmaceuticals. I mean the availability is one thing, but if you’re talking about the risks and benefits, which is what the drug ads are designed to do and mostly to hype up the benefits while the risks are downplayed, in fact there’s a whole psychology of that.
There’s a psychologist, I think she was from Duke University, who testified in Congress about that—the techniques that marketers would do would carry out in their ads to make the benefits reach the mind of the listener and the viewer more completely, while the risks were being buried under music or spoken in a lower tone of voice or hidden under more activity on the screen so that the risks [were downplayed]. So while they’re reading off a list of things that could happen to you if you take this drug, those tend to not sink in, whereas the benefits tend to sink in, and this is a psychology that marketers use.
That’s why the risks and benefits should not be advertised on television at all; whether it’s the internet, whether it’s television, that’s not the issue to me. The issue is that you’re being sold a product without a fair ability to evaluate what you’re getting into for someone else’s profit.
SR: What do you think the public should do? People seek medicine in crises. They’re vulnerable. They’re looking for simple answers to complex problems. What could they do if they’re being sold a product without sufficient knowledge?
DA: The problem is how our doctors are educated, and it’s part of the same syndrome. The pharmaceutical companies are in the business to make money, and they have marketing departments that are at least as big as their science departments. So, besides the direct to consumer ads on television, they have a team of what are called detailers that go to doctors’ offices and those detailers are given scripts on how to sell the drugs to doctors. Just today somebody sent around an article, I believe it was from the Boston Herald, about a study showing that doctors prescribe more opioids after they’ve been taken to lunch by a drug detailer. That is human nature, and the companies exploit it.
Going back to some of my other cases, there were doctors being flown to Las Vegas, doctors getting free golf, doctors getting massages, doctors having sexual favors provided by drug companies, all in the name of influencing them to prescribe the drugs along with a pitch that would be a slightly more sophisticated version of what the consumer is getting on television, namely, emphasizing the benefits, downplaying the risks.
Now there is a guy, a really well-respected Harvard pharmacoepidemiologist, which means he studies the epidemiology of pharmaceuticals. His name is Jerry Avorn, and he has created what he calls “academic detailing” as an antidote to commercial detailing; detailing meaning the process by which a drug company informs or misinforms a doctor about the risks and benefits of a drug. He has set up a company that will provide a service to public agencies that want to educate their doctors on the academic information about a drug rather than commercial information. This is talking about the risks and benefits in a more fair and open and balanced way—what the doctors would learn from the academic detailers instead of getting a one sided picture from the commercial detailers. There is one fairly significant problem with that, though, which is that academic detailing depends on what’s in the published literature and the pharmaceutical companies have an outsized impact on what gets published. It’s very hard to get independent research published about drugs.
SR: So what do you think is the smartest thing that people can do to be informed?
DA: There are doctors I’ve read about whose practice is to not prescribe drugs until they have had experience in the marketplace of X number of years, whether it’s 3, 5, 7, 10 years, so that a safety profile can be established for a particular drug, rather than simply going on, “Oh, the FDA approved it, therefore it must be safe.” That is just not true and why so many drugs have to have new warnings [labels] or get taken off the market after they have been approved by the FDA. The process for approval of a drug is not sufficient to really establish its safety, and this is well known. It’s well written about.
There’s a program called pre-approval investigation, which consists of somewhere around three to five thousand people who have been chosen by the drug company to participate in these clinical trials in the hopes that they will not show any ill effects of the drugs. That means they tend to be younger, healthier, not taking simultaneous medications that could interfere with the metabolism of the drug being tested because that could make the drug being tested more dangerous if there are competing drugs.
How can consumers be safer? One way is to not take drugs that have just been approved because the odds are much greater that a drug that’s just been approved will be something that has risks that are not yet known. So if you’re going to a doctor you might want to ask the doctor, “Well, this drug that you’re recommending for me, how long has it been on the market, what do you know about its safety profile?” If the doctor says it was approved six months ago and we don’t know that much, see if there’s another drug in the same class. There are lots. While new drugs come out, there are many drugs that some doctors would call a “me-too” drug, meaning it’s in the same class as the new drug that does the same thing, but has been around for longer and has a more established safety profile.
Beyond that, you would want a new administration of consumer protective senators, congressmen, presidents, and legislatures around the country, as well as an FDA that was not a revolving door for members of industry.
SR: That was what I was going to ask about next. When you look at the people who are now running these agencies, expediting these approvals, what do you see?
DA: They came from industry. And they go back to the industry after they leave the FDA and I’ve seen that. I’ve been working on these pharmaceutical cases since 1997 and that’s only half my legal career. But it’s a pretty substantial chunk of cases and a pretty substantial chunk of evidence, and what I’ve seen is that people in positions of authority at the FDA previously worked for drug companies, and people in drug companies positions of authority previously worked for the FDA. So the fox guarding the chickens is very real in this case.
SR: This is very helpful because people should know what they can know do, especially when they are in crisis situations. Let’s shift gears to your music.
DA: Okay, but before we move on, I just want to show you that even before I started working on this as a lawyer, I had written a song called “Ask Your Doctor.” It’s a rocker.
SR: I wanted to ask about that. When you see what’s happening to science, public health and government these days, where do you go to take care of yourself? I know the answer partly is music, but writing political songs is hard to do well.
DA: I am still drawn to that, but music isn’t the only place I go to take care of myself. I also do Tai Chi, I exercise regularly, I try to eat in a healthy way, I try to maintain relationships, including the most important one with my wife and my son, who still lives here, my older son that’s off at college but I’m still in touch with. And maintaining human relationships, I think, is a very important part of a healthy way to be on the planet. As far as music is concerned, it definitely is an important for me to express how I’m feeling and thinking. There are occasions over the years where what I’m thinking about is the social and political atmosphere comes together in a song and expresses that best for me.
That doesn’t happen often, because it’s hard to write a political song that isn’t preachy. It has at least some aspects of poetry. I don’t claim to be a Bob Dylan. Nobody’s going to write “Blowin’ in the Wind” again. But if you can write a song that has meaning and is not trite, those are the bars I set for myself, and it’s melodic and it catches people’s ears—when people listen to it, I can tell that it touches them.
SR: What’s the latest example of that?
DA: The latest example is “Everyone Comes From Somewhere,” which is now somewhere up to 50,000 views on a Facebook page and my own website and has had quite a bit of attention. It has had a great response there, and I get really gratifying comments. I would say the 99.9 percent of people that respond to it are liking it, and a lot of them are Mexican-Americans, who are saying thank you, we really appreciate that sentiment, I like this song... Those probably mean more than anything to me as far as who’s responding because it’s such a toxic atmosphere that we’re living in...
That atmosphere has been created by right-wing, anti-immigrant, anti-people of color sentiment. That was what was going through my mind when I wanted to write that song. But also to honor the fact that I come from immigrants, it’s just a couple of generations earlier. It’s so arbitrary to say “oh, we’re all here, let’s close the doors,” and to me that was one of the metaphors. I won’t be the one to close the doors—well I won’t. I think the doors should stay open. I think that immigration helps us as a people, it helps us as individuals and as a culture, so that’s a recent example.
“Hope Is Hard to Kill” is another one. I wrote that pretty much at the same time about the idea that we always go through hard times and we always have to be resilient and fight back.
SR: Yeah, sometimes it’s hard to have hope, but on the other hand...
DA: It’s really hard not to.
SR: Thank you for going over all this. Exposing the deceitful way medicines are marketed and reminding people to have hope.