Pharmaceutical Research

Benitez 12
















Lindsay Benitez
Scott Harris
355:103 Exposition and Argument
10 December 2016
Why do people continue to trust big pharmaceutical companies when exploitation is exceptionally visible?
Take as Prescribed
The interactions that occur between society and its members are rarely equal. Where one individual gains, another may lose twice as much. The reasons for such varying degrees of success cannot merely be attributed to a person's innate work ethic or determination; instead a person's success can be attributed to how their initial social status is cultivated and manipulated in a way that ultimately allows for them to financially dominate everyone around them. A financially secure member of society holds an influence that cannot be matched. As a result, their decisions lead to a chain of events that affect the rest of the public. In turn, this monetary form of control leads the public to constantly question the choices made by those in positions of authority. Leaders at every frontier of society are continuously interrogated for the validity of their actions, not to mention those at the head of the pharmaceutical industry.
There are many controversies relating to the intentions of Big Pharma companies. For example, leaders are either condemned for bathing in corruption by spreading false information and altering the views of doctors, or they are praised for the drug innovations produced by their companies that extend the lifespan of thousands of people. The heads of Big Pharma companies undoubtedly believe their successes to be earned and their profits justified. For instance, the CEO of Turing, Martin Shkreli, whole-heartedly defended the 5,000% price increase for the drug Daraprim in 2015. Similarly, Heather Bresch, the CEO of Mylan, defended the six-fold price increase of the EpiPen earlier this September. Other members of the public, however, namely those who are knowledgeable of the subject matter yet aren't of an equal socio-economic status, see the discrepancies within the industry and fight to keep the rest informed. Why do people continue to trust big pharmaceutical companies when exploitation is exceptionally visible? Members of society continue to rely on these companies because their psyche is misled by abused social influence. Through a prominent social influence companies take advantage of unspoken social "rules" and use persuasive schemes to further their agenda. Persuasive schemes ultimately allow pharmaceutical companies to convince the general public to buy expensive drugs, influence doctors to prescribe unnecessary drugs, and collude with the FDA in order to approve drugs that are potentially harmful.
The ideas and products of the Pharmaceutical industry are spreading as a result of abused social influence. The psychology behind social influence is that a change in a person's attitude and opinion may be caused by the ideas and actions of another. For example, when laypeople see researchers, scientists, and doctors all around them disseminating information that seems intelligent, the lay people can't help but change their original points of view to match those who are seemingly accomplished members of society with merited reputations. Big pharmaceutical companies abuse their social influence by aggrandizing their importance through the excessive use of advertisements. Tagore talks about the ways in which companies deceive the public. In 1997, a company's responsibility to provide the FDA with extensive details concerning all possible side effects (regardless of its rarity or detrimental consequences) became extremely relaxed. From 1997 to 2000, "Spending on drug advertisements aimed at consumers skyrocketed, from a mere $844 million ...to $2.2 billion…" (Tagore 663). Through lax side effect regulations, companies were easily able to take advantage of direct-to-consumer advertisements because they were no longer responsible to share the same level of accurate information. The exponential increase in advertisement spending (250% in three years) explicitly shows that companies were eager to show more to consumers because of the higher level of information that was allowed to be withheld. Vague advertisements let consumers trust that they were buying something that is safe, when in fact they were baited into buying overpriced or unneeded drugs, without entirely understanding the repercussions. The fact that companies are able to spend billions of dollars on advertisements adds to their immense social influence. They are simply a force in society that cannot be ignored, and they themselves are absolutely confident of this.
The confidence that Big Pharma companies convey as a result of their social influence not only detracts consumers, but it also detracts physicians from the truth. When a company within the industry claims something with absolute certainty, even if it is false, that same claim solidifies and spreads outwards making it difficult to negate. The social influence of certainty becomes abused when the industry solidifies and disperses falsified or manipulated ideas and information. It must be acknowledged that any company with the ability to directly send letters to over 6,000 doctors is a company that has some level of prestige. Tagore continues to talk about Pharma manipulation when he relates that in 2003, "...Johnson and Johnson… misled doctors over the risks associated with the antipsychotic drug Risperidone. [The court] declared that the company engaged in 'false or deceptive' acts...when [the company] sent a letter to 6000 doctors claiming that it was safer than its rivals." (662). Thousands of doctors were misled by Johnson and Johnson's claim that their drug was "safer than its rivals." How? First of all, Risperidone is an antipsychotic. This means it treats disorders such as schizophrenia and bipolar disorder which, to this day, aren't understood in all of their entirety. Since the certainty surrounding prescriptions for mental disorders is highly controversial, it can be reasoned that Big Pharma capitalizes on the ignorance of physicians with an overbearing confidence that allows their product to be sold. This is relatable to how they take advantage of the misinformed public through advertisements. The fact that ignorant Physicians are easily impressionable supports Chang's argument, that "...an individual's utility is affected by both personal income and a social comparison made with others within a society" (513). In essence, when physicians are forced to make a "social comparison" between themselves and a pharmaceutical company that has the backing of hundreds of researchers, they may feel inutile and instead resort to relying on the influential confidence that pharmaceutical companies display. Overall, social influence is what influences society to continue to believe that they need what these companies have to offer. Koriat writes a psychological paper concerning how and why individual and group decisions are made and influenced. He says that "... when groups attempt to reach a … decision, they rely more heavily on the more confident members: For each issue, group members who are more confident in their judgments tend to have a greater impact on the decision …than those who are less confident" (947). Since Big Pharma companies express more "confidence" that hold more of an impact, physicians tend to trust their judgements and opinions when it comes to making important decisions such as what drugs to prescribe to their patients. The presence of such confidence isn't questionable because it is made evident in their willingness to carry out harmful actions without fear of reproof. Also, their impact is obviously evident through their continuing financial success and the fact that although loads of misinformation is present, physicians continues to gravitate towards their ideas and products. It can be argued that their lasting success is a result of the appearance of false mutuality between themselves and other groups.
Companies in the industry take advantage of social obligations or socially acceptable rules that are intrinsic to a community, such as reciprocity, and use them so that consumers continue to come back for more. Reciprocity describes a mutual relationship that takes place between two parties in which they are both benefitted. For example, this seemingly occurs in the relationship between Big Pharma companies and research universities. In the world of science, experiments within a university require an extensive amount of funding in order to make way for a possible discovery. This leads universities to seek some sort of monetary assistance from big-name companies; including those in the pharmaceutical industry. It is interesting to note that research/reports sponsored by Big Pharma companies are "... four times more likely to favor a pharmaceutical company's product [when] compared to independently published data" (Keller 399). Within a society, members who receive aid often give back to the other members who help them. Similarly, research universities payback the monetary assistance that they receive in the form of recognition. Why do this, if not with the foreknowledge that their continued recognition will lead to a continued flow of donations. It can be concluded therefore, that students within a university continue to support Big Pharma companies for their own gain, to continue to receive the benefits that come with being affiliated with them. However this is a false sense of mutuality because one party is way more dependent on the other. Universities only break even, receiving money in finite amounts that will always diminish; however, Big Pharma companies receive more lasting effects including a better reputation and increased profits. Big Pharma businesses solely reciprocate for the growth of the company. Giving to institutions can be seen as a form of investment, expecting return in the form of recognition. This recognition can be seen as another form of self-advertisement, to build on the paragraphs preceding this one. Consumers now doubly trust influential Pharma companies with the backing of prestigious universities, serving to increase the profits of the company.
Reciprocity not only takes place between Big Pharma companies and educational institutions, but also between doctors and the drug representatives that the companies send out. Lieb's articles serves to comment of the physical relationship between doctors and pharmaceutical companies. He notes that "...gift acceptance and the belief that one is receiving adequate information from a [drug representative] are associated with changed prescribing habits" (1). It can be established, therefore, that doctors do not have fixed prescribing habits, but instead they are capable of changing their habits based upon the influence of drug representatives, some of whom may have completed up to three times less schooling than them. This influence comes in the form of gifts and information. Although rules have become more stringent concerning the relationship between drug reps and doctors and what gifts can be given, there are still several loopholes. Doctors are "...treated to conferences in posh hotels, with free accommodation, food, and even alcohol" (Tagore 665). Doctors are charmed and cajoled to the fullest extent and all of these pleasantries are allowed so long as the drug company is holding an event that provides some sort of "educational content" (Tagore 665). It is only natural for doctors to want to reciprocate the drug companies since they are keen on accepting these forms of self-indulgence again in the future. The fact that 94% of physicians have any form of relationship to the industry is extremely alarming since that immediately implies that 94% of our doctors are being influenced in unorthodox ways (Campbell). This raises another question: are doctors really prescribing medications to benefit their patients, or are they altering their prescribing habits to continue to receive perks in the future? This form of influence compares to the flattery that the elite imposed on their recruits in the essay written by Ho. Mixing students from elite universities with a perfect life style achieved through investment banking "...is crucial to the recruitment process, reproducing as it does the ambience of Wall Street cocktail parties...in lavish, impeccably catered settings"(177). Here the reader notes that it is "crucial," or absolutely necessary to give materialistic goods to a certain group so that they can be influenced in such a way that it is eventually reciprocated. In this case, investment bankers favor students with materials, knowing that the elite students will eventually reciprocate them by becoming employed and serving the company in order to increase their profits. Clearly, this is also made apparent through doctors and the industry. It seems that the spirit of reciprocity allows for consumers to not only establish some sort of superficial relationship, but also this superficial relationship is what motivates consumers to give some level of trust.
Reciprocity is also taking place between the FDA and pharmaceutical companies, allowing for a collusion that not only benefits both parties but causes ignorant consumers to fall into the trap of misinformation. In the early 2000's Daniel Troy, previous chief council of the FDA participated in legal suits on the behalf of drug companies, not the working Americans (Richards 29). This is interesting to note because the FDA was constructed to protect public health and interests against greedy pharmaceutical companies, but in the action of defending the billion dollar companies we see a changing of sides taking place. In his research, Richards finds "...that the FDA and a drug company can work on a drug's approval, keeping adverse data from the public...information that the FDA or a drug company does not want known (suicidal thoughts and cardiovascular problems) could be omitted" (31). It is expensive for the FDA to keep drugs on a "waiting list, "continually testing them, waiting for them to become legitimate enough for human trials. As a result, the FDA is becoming impatient and wanting to fast track the approval process of all drugs. In the same way, pharmaceutical companies want their drugs to be fast tracked so that they can begin making profits as soon as possible. By recognizing that the needs of both sides parallel each other, they begin to work together to reach a common goal. The FDA, being a company whose mission statement is to assure the safety of drugs, medical devices, food, and other biological products is supposed to be highly trusted, and seen as an association whose purpose is to filter the misleading information that is spewed by Big Pharma companies. Consequently, consumers put trust in their actions, believing that everything approved by them is safe and beneficial. This couldn't be farther from the truth. In Keller's article, the unclear relationship between the FDA and Big Pharma is expired. When the big drug company Pfizer, failed to provide risk information for the drug Chantix, which "...carried a black box warning (the most serious alert) on its packaging relating to suicidality", all the FDA did was issue them a warning letter (Keller 399). The "black box warning" indicates that there is a serious hazard affiliated with the drug - it is the most severe warning developed by the FDA. So then why would the FDA not generate a harsher punishment for for the companies that are putting lives at risk? Ultimately, FDA companies may not want to negatively affect their cozy relationship with pharmaceutical companies, and they subsequently issue mild punishments so that no serious damage is done to their relationship.
Those in the industry also use amplification as a means of persuasion to get their mission accomplished. Amplification takes place when companies align their attitude with the projected attitude of consumers so that the acceptance of their agenda is voluntary and doesn't seem forced. For example, if someone is trying to convert another person to their religion, the converter will agree with mostly everything the other person is saying, but the converter will agree harder on points that help them prove their own (Koriat 948). When we amplify what we want to get across to others without outright rejecting them, they are more conditioned into seeing things our way. Companies usually partake in disease mongering, which "... widen(s) the boundaries of treatable illness(es) in order to expand markets..." (Tagore 664). Basically, although a drug may only be certified to treat one specific illness, companies train drug representatives to tell doctors that the drug can treat more than what's on the label. In essence, drug reps amplify what the doctors want to hear and provide a product that mimics their needs. An example of this is when Paroxetine was used to treat social phobia. In the late 1990's social phobia became the new "hyped" mental disorder, ranking third in the country, right after depression and alcoholism. This drug had already existed to treat other ailments in the past, but Drug companies expanded the horizons of what the drug could treat by adding social phobia to the mix (Tagore 664). It was a never a new drug that was specifically directed at this mental disorder, but instead it was an old drug whose use was altered to fit the needs of a population whose needs were slightly shifting in another direction. In the end, patients end up with a drug that was never specialized, and therefore, not needed. The only function amplification offers is an opportunity for Big Pharma companies to widen their profit margin. By altering the uses of pre-existing drugs, the same drugs are being sold for different reasons. No money was spent on new experiments or testing, which really saved them a lot of money. As a result, companies fail to provide the public with helpful innovations, manipulating society into buying drugs that they don't need. This lack of innovation was also present in the company's sponsorships of large universities, where the universities did all the innovating while the company received the credit. This may even be compared to rent-seeking. One form of rent-seeking takes "...advantage of asymmetries of information (selling securities that they had designed to fail, but knowing that buyers didn't know that) …" (Stiglitz 399). Again, we see the manipulation of information by monopolies who take "advantage" of the ignorance of their consumers. Monopolies reap benefits from an ignorant working class without any real form of innovation.
Some may argue that the actions of the elite (namely, those in the pharmaceutical industry) should not be judged with such brutality when there is much more pressing social issues surrounding lower class individuals. This couldn't be farther from the truth, as lower class individuals are often used as scapegoats for modern social issues. Gans reports that "Mainstream culture believes that the poor people who behave (inadequately)... do so because of moral deficiencies or bad values" (2). Due to the rates of crime and the often explosive and unmerited reactions from mainstream media, society's initial reaction is to believe that the poor behave more unethically and are in greater need of intervention. However the department of Psychology at the University of California, Berkeley, ran seven studies and concluded that in fact, the opposite trend occurs. "Great resources, freedom, and independence from others among upper class give rise to self-focused social cognitive tendencies, which… facilitate unethical behavior" (Piff et al 4086). Therefore, the resources made available to those in the upper-class actually "facilitate" immoral tendencies. This shows that issues in morality start at the top, or more specifically, at the top of pharmaceutical companies. If any intervention needs to be made it would have to start with the elite- the minorities who have the greatest effect on society. In essence, although influential members of the Pharma Industry makeup a tiny percentage of the population, they essentially control the output of millions of drug prescriptions (affecting the lives of millions). They have an overwhelming influence, and their actions should first be monitored before anyone else's so that a worse spread of immorality doesn't occur. The important social issues that define our society today are not a result of the actions of the underclass, but instead a result of the inaction of the elect to be morally responsible.
The ideas and products of the drug companies become solidified due to a social influence that leads to a multitude of other byproducts such as reciprocity and amplification. Pharmaceutical companies create a world in which all those below them are the victims, while they continue to be the predators. Although collusion occurs on many levels, the Pharma companies are the parties that gain the most, due to the fact that all other parties are dependent on them. They amplify what they think the majority of the population wants to hear while being responsible for the very social issues that plague the underclass majority (whether it be poverty or drug addiction). Are social issues such as drug addiction primarily the fault of users or are they a victim of over-prescription, another common issue amongst our society today. It all circles back to the amount of trust members of society put into Big Pharma companies; a trust that is taken advantage of and mocked.





















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