Author: Kalman Applbaum
Position: Associate Professor
Institution: University of Wisconsin-Milwaukee
E-mail: applbaum@uwm.edu
Submitted Date: August 07, 2008
Published Date: August 11, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Marc-André Gagnon and Joel Lexchin are to be congratulated for pinning down, analyzing and reporting the data leading to the conclusion that the U.S. pharmaceutical industry spends nearly twice as much on marketing as on R&D. This trend is associated most strongly with the industry’s quest for blockbusters since the early 1990s, and is directly related to the high proportion of “me too” drugs being approved by the FDA—as high as 92%, according to one study.[1] Merrill Goozner estimates that “Three out of every four drug applications involve drugs that either replicate the action of medicines already on the market or [are] new formulations that at best add minor conveniences for patients and doctors.”[2]

We can add to this the fact that many clinical trials (competitive trials in particular), publication planning and many other classified-as-R&D activities are in fact devoted to non-exploratory efforts to improve market share or to maintain hold on profits associated with impending patent expiries (“evergreening”). These can be called ‘adjunct-to-marketing’ R&D activities as opposed to ‘exploratory’ R&D activities. In light of the high rate of me too submissions and approvals, and in light of the probably high ratio of ‘adjunct-to-marketing’ to ‘exploratory’ R&D activities, Ganon and Lexchin’s estimate might have to be revised upwards several times. Internal company budgets may be difficult to obtain. However, if we were to take Goozner’s estimate of 3:1 (Me-too:real innovation) as a proxy to the overall figure for ‘adjunct-to-marketing’ to ‘exploratory’ R&D activities, the new ratio for spending between marketing and R&D balloons to eleven to one. Just a thought exercise awaiting further empirical investigation.

We can remain grateful for the wealth of pharmacological remedies available to us. The new marketing-driven approach to pharmaceutical invention and sales, however, is far more preoccupied by the efforts to expand corporate dominion over medicine through pervasive campaigns to “ghost manage” the conduct of basic science, to influence prescribing practices, to market medical conditions far beyond their natural incidence, to alter the criteria for the threshold of disease risk, or to beget new drug-bound diagnoses altogether.[3] Until we recognize (quite contrary to industry logic) that from the point of view of public health, marketing and R&D are not complementary but competitive functions, we will remain unable to address the inimical ascendancy of the marketing model in pharmaceutical drug development.

1. http://yaleglobal.yale.ed... accessed August 7, 2008.
2. www.gooznews.com/archives... accessed June 20, 2008.
3. Healy, David. 2006. “The New Medical Oikumene.” Global Pharmaceuticals: Ethics, Markets,
Practices edited by Petryna A, A. Lakoff, A. Kleinman, eds. Durham: Duke University Press. pp. 61-84. Healy, David. 2007 “The Engineers of Human Souls and Academia.” Epidemiologia e Psichiatria Sociale. 16(3): 206. Sismondo, Sergio. 2007. “Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry?” PLoS Medicine 4(9): e286 doi:10.1371/journal.pmed.0040286. Oldani, Michael. 2004 “Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices.” Medical Anthropology Quarterly. 18:325-356. Avorn, Jerry 2004. Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs. New York: Knopf.
Moynihan R, Heath I, Henry D. 2002. “Selling Sickness: The Pharmaceutical Industry and Disease-Mongering.” British Medical Journal 324:886–891. See also PloS Medicine collection of articles on disease mongering at http://collections.plos.o....