Greg Palast my favorite investigative journalist wrote in a piece on the Huffington Post that Obama's big deal with Big Pharma saves $80 billion out of a total $3.6 trillion. That's 2%. Whoop-tee-do! This is like making a deal with the devil. Today the Huffington Post lists the health care industry executives who have been visiting the white house only because freedom of information suits were filed and the white house was forced to reveal them. It remains to be seen what will happen now with all the back tracking. No wonder he has been keeping quiet, pretty scarey.

I had doctors tell me they were not swayed by the drug companies even when they gave them free vacations. Horse crap! The ones who refused the free stuff from the drug companies were the only ones I felt had any ethics. The AMA itself for years have sold what are called prescriber reports or prescriber profiles which list every prescription written by each doctor in the country. The federal government has also sold this type of information using the DEA numbers of physicians for large fees. Pharmacies have been known to sell information on prescriptions written by specific doctors. In more recent times doctors have been given the option to not have their information included in the reports from the AMA .
By putting together all of this information, the weekly prescriber reports can show the names of the doctors in a rep’s territory and what each doctor prescribed and how much of it. Reports provide reps with up-to-date feedback on just how effective they've been in persuading their doctors to prescribe the two or three drugs each rep pitches. The reps are schooled for weeks in a variety of sales techniques. They memorize tightly crafted speeches and volumes of data on their products, and some are even trained in personality profiling, to help them guess whether a physician is more likely to respond to reams of scientific research or to schmoozing. Prescriber reports play a key role in helping reps boost sales—they're like weekly focus groups that help reps shape their pitches to individual doctors. If Doctor A increased her prescriptions after being treated to a facial and full-body massage, more expense-paid spa excursions are in order for her. If Doctor B didn't respond to a courtesy five-course meal, then maybe it's time to try football tickets, or up the free drug samples, or plug clinical research that touts the proffered drug's benefits.
Prescriber reports also allow reps to identify and target their top prescribers. The reports rank doctors into four tiers, based on how many scripts they write. Reps focus most of their energy on the upper ranks—the doctors who write hundreds of prescriptions per month. That's because a rep's bonus depends on increasing market share, the sales of his drugs in his territory compared with competing medications. Getting top prescribers to increase their prescriptions by even a few percentage points can give the rep that needed boost. http://www.slate.com/id/2119712/.
Some states have passed laws banning the practice of sharing prescribing information with drug companies. They are fighting these laws:

A federal judge has upheld a Vermont law that bars the release of physicians' prescribing information to drug companies, which then use the information for marketing purposes.

U.S. District Court Judge Garvan Murtha in April rejected a suit by "data-mining" companies challenging the state law that bars access to prescribing records without consent of the prescribing physician. http://pn.psychiatryonline.org/cgi/content/full/44/11/3.
I once had a doctor throw a chart at me after he told me about the fabulous vacation he was going on and I made a nurse bitch-woman comment to let him know I knew it was a drug company bribe. Another doctor with ethics had already told me a drug company offered him this same vacation deal. There are doctors who would not let the drug reps in their offices and I have the greatest respect for them because profit was not their main concern, patients were. More and more the medical community has learned over the years the truth  about the drug industry's deceit and due to patient concern will not take information or drug samples at all from them. They get their information from scientific journals.
One part of the pharma story which helps to form my outrage that President Obama would go behind the backs of the American people to make a deal with the Pharmaceutical Industry points very strongly to the fact that they have been standing on the backs of Americans(and people in other countries) to make insanely greedy amounts of profit. They have used their expertise at neurochemistry to shape medications which cause addiction into a pretty package which makes them look like they are not very addicting. Physicians do not have enough time to read all the details of every medication on the market. The problem is they are generally being guided by the drug companies in the choices they make and our FDA has done a poor job of regulation. The FDA is pretty much owned by the drug companies and most of the drug research in this country is financed by drug companies. When I worked as an RN I would always try and find the smartest pharmacist in the hospital to use as a reference. The smartest one I knew was an addict himself and told me the process of addiction starts with the first pill. A lot of the things he told me made me start to question what was going on with big pharma.

Each week Larry G, as he identifies himself on the air, exposes the dark side, the truth about the prescription drug epidemic that is sweeping the country. He points out that somewhere the drug companies lost their conscience and forgot that their purpose was to do good, not just make profits. Of course, if making profits is your only goal, then, like the Nazi concentration guards who were only doing their jobs, their employees can more easily ignore the screams and agony of their victims and the steady stream of obituaries caused in large part by the public not realizing that their welfare is secondary to the profits of the drug companies.
As the director of Novus Medical Detox Center, I daily see the ravages of prescription drugs that chemically are little different than heroin or cocaine and, of course, are just as addictive and destructive. At Novus we see the shattered lives and broken families created by people who obtained their drugs, not in a dark alley, but at a pharmacy using a prescription written by a doctor who is too busy to investigate the true cause of the physical problem the person is having and instead just prescribes the current drug fad being promoted by the drug companies' sales representatives. http://novusdetox.com/newsletter/newsletter2-11-08.htm.
In 1978 Bristol Laboratories started marketing Stadol a pain medication which they claimed to be non-addicting. The FDA’s own drug abuse counsel advised the FDA to make Stadol a scheduled narcotic and the FDA failed to do so. Bristol Laboratories marketed it to doctors as being a remarkable break through in pain management. The FDA has a long history of corruption, especially in the area of getting jobs with the pharma industry when they leave the FDA.

However, this action by the DEA is 19 years too late for many consumers who were not warned of butorphanol's addictive properties and were unwittingly made dependent on this drug while it was being heavily promoted to doctors as non-addicting by its producer Bristol Laboratories now Bristol-Myers Squibb of Princeton New Jersey. Many consumers would have been warned about butorphanol if the FDA had heeded the recommendation of its own Drug Abuse Advisory Committee to control butorphanol when it was first approved in 1978. At the same time that butorphanol was being approved, the FDA also disregarded the dependence caused by pentazocine (Talwin), another potent pain reliever, and chemical cousin to butorphanol. Experts predicted that pentazocine, like butorphanol, would cause dependence, but pentazocine was approved without control in 1967 and was marketed for 12 years as a non-addicting pain reliever before being regulated as a controlled substance in 1979, shortly after the approval of butorphanol in 1978.
Unfortunately there is a well established pattern in the United States of drugs that should have been initially regulated as controlled substances, which were then heavily promoted to doctors as safe and nonaddicting by their manufacturers after their approval without controls, then were uncritically accepted by the medical profession as breakthrough drugs, and ultimately unsuspecting consumers became dependent on them. This pattern is now being repeated with another pain reliever Tramadol (Ultram), a drug that was known to be addictive before it was approved, but was approved in 1995 without controls and remains uncontrolled today. Dependence with butorphanol, pentazocine and tramadol was predictable. Considerable harm could have been prevented if these drugs had been initially been regulated as controlled substance, thus warning consumers of their of their addictive properties. However, as long as regulatory authorities continue a policy of not controlling a drug until a significant public health problem has emerged and large numbers of consumers have been injured this pattern will continue to be repeated. Butorphanol, pentazocine and now tramadol raise serious questions about the effectiveness of controlled substance regulatory policy in protecting the public's health.
Controlled substance regulation, as exemplified by butorphanol, pentazocine and tramadol, strongly favors protecting the marketing potential of a new drug and the economic interests of drug companies at the expense of consumers unknowingly becoming drug dependent. These three drugs were predicted to cause physical and psychological dependence based on their chemical similarities to morphine and their ability to interact with the same brain receptors as morphine. Public Citizen believes that chemical structure and brain receptor characteristics must be strongly considered in initially classifying a new drug as a controlled substance. The burden of proof must rest with drug companies to show that new potentially addicting drugs, based on their similarities to drugs known to cause dependence, in fact, do not injure consumers in valid post-marketing studies. http://www.citizen.org/publications/release.cfm?ID=6620/.
I have a painful condition called Atypical Trigeminal Neuralgia or Tic Delaroux, in the early 90s my pain was very bad and I was sent to see a neurologist who was well known for his love of treating head pain. He actually diagnosed me with atypical migraines at the time which was based on the knowledge level then. He prescribed Stadol for me which I was to squirt up my nose when the pain was bad. I asked him what category of drug it was and got a vague answer. He told me, “We use Stadol because it has a very low potential for addiction, most of my headache patients are using it and it has the added effect of causing sedation so the patient can sleep.” Sleep is one of the best treatments for headaches. At that time I was in agony and I believed he knew what he was talking about, so I used it. A few months later I got a frantic phone call, “We just found out Stadol is highly addicting and we are not going to be giving it to our patients anymore.” I then asked the caller what they were going to do now that they had gotten us all addicted to it. She answered honestly, “Nothing.” There was no assistance with the withdrawal or referrals to any kind of treatment or support. This is how I became an addict, just like thousands of others in this country. There is a class action lawsuit right now against this drug company to help compensate people who have been harmed by the lies from Bristol Labs now called Bristol-Myers Squibb in Canada. I only recently found out about the truth behind my own addiction to Stadol.

I know an emergency room nurse who was working in the ER one day and had a headache. She went into the closet where all the drug samples were stored and decided to use the new drug Tramadol or Ultram, which the drug rep had told everyone worked a lot like an NSAID(Ibuprofen type). I know this because one of them told me it was an NSAID.  It did not occur to her it would be a prescription drug. She kept having headaches and everyday went back more and more for Tramadol. Her coworkers were noticing she was taking a lot of it. She got addicted to it because the drug company lied. It does not make people high like other narcotics, but it is addicting. She told me she just had a feeling of looking forward to taking it everyday and was puzzled by it and then she could not stop herself from taking it. She had to go to drug treatment and participate in a chemical dependency program for nurses. She was a person who never even drank alcohol. I once got in an argument with another nurse who was on Tramadol in New Mexico when I told her it was a narcotic. She had been on it for years. I think the degree of anger that she exhibited said it all. She was defending her drug just like any other addict.

While I was participating in a group for chemically dependent nurses myself I told the group Immodium had to be a narcotic. Practically the whole group jumped on me and told me I did not know what I was talking about. Then when I asked my gastroenterologist to help me figure out why I had chronic diarrhea he screamed at me as loudly as he could, “If you have diarrhea take Immodium.” I screamed back, as loud as I could “I am addicted to narcotics and Imodium is a narcotic you stupid son of a bitch.” He then told me it was not a narcotic. My reply was I had read the pharmacodynamics and the procedure for overdose which requires narcan a drug used to reverse the effects of narcotics, it is a narcotic. They have some in the medical community bamboozled. Loperamide does not cross the blood brain barrier easily, so it does not have the same effects as a lot of other narcotics. Yet, it does cause dependence.

Of course Immodium does not produce a high feeling, so it does not occur to people who have chronic diarrhea and take it everyday they may develop a dependence. Occasional use carries no risk, it is those who have a big problem with loose stools and use it a lot who may have dependency issues. Of course there are people who have no choice as they can’t leave home unless they take something for diarrhea. The point is people should be warned about the potential risk and taught alternatives to medication for this problem. We all have a right to be fully informed about the medications we put in our bodies. The FDA says it has a low potential for addiction. Yet it also says this:

Studies in morphine-dependent monkeys demonstrated that Loperamide hydrochloride at doses above those recommended for humans prevented signs of morphine withdrawal. http://www.drugs.com/pro/loperamide.html.
People who are in withdrawal from narcotics will often use Lopeamide to ease the symptoms. People who take it for a long time can have physical withdrawal syndrome and there should be a warning about that. When first introduced it was a scheduled narcotic and then removed from scheduling so the drug companies could sell it in the over the counter drug market. Researchers are studying Loperamide for potential use as a pain medication.

On Jan. 30, 2009 an FDA advisory committee voted that Darvon’s (Darvocet is Darvon with Tylenol) risks outweigh it’s benefits and say the drug should be banned and it should be removed from the market. Now, how long did it take them to figure this out? It has been around a long time.

Most advisory committee members did not think there was evidence that the drug has significant benefits. Without benefit, serious risk of death – which this drug carries – should not be tolerated. In Florida alone, medical examiners determined that propoxyphene caused the deaths of 85 people in 2007. For 25 of those people, it was the only drug that caused their deaths. These latest data come atop years of other data showing that the drug’s risks outweigh its benefits. http://www.citizen.org/pressroom/release.cfm?ID=2814 
Darvocet does almost nothing for pain, it is the Tylenol which mainly works on the pain. Darvon is addicting, but does not work all that well for pain and it causes depression which can result in suicide. All narcotics cause depression. Darvon (generic: propoxyphene) has been associated with over 10,000 deaths and 2,110 reported accidental deaths in the United States. It forms a metabolite that is toxic to the heart. The Journal of the American Medical Association, published a study over 36 years ago in which they found that Darvon or Propoxyphene was no more effective that two aspirin tablets, yet they continued to prescribe it. In 2004 23 million prescriptions were filled. On July 7th of this year the FDA denied a petition from Public Citizen to ban the drug. They have wimped out once again. They basically issued a statement that more research on the effects on the heart be done, warned about excess Tylenol use, and overdose. They did not even address the suicides it has caused from depression. Who got paid off this time?

The problems of addiction to Oxycodone drugs is growing and the withdrawal symptoms are excruciating, thus leading to crimes such as robbery, theft, and prescription fraud. Lives are being ruined and people who trusted their doctors, drug companies, FDA, and DEA now have criminal records because they just could not stop using the drug. To add to the problem early on addicts figured out they could crush the long acting pills and take all of the oxycodone it contained at one time. Some Oxycontin addicts have turned to Heroin because it is cheaper to get.

The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.
To resolve criminal and civil charges related to the drug’s “misbranding”, the parent of Purdue Pharma, the company that markets OxyContin, agreed to pay more than $600 million in fines. That is the third-highest amount ever paid by a drug company in such a case.
Federal officials said that internal Purdue Pharma documents show that company officials recognized even before the drug was marketed that they would face stiff resistance from doctors concerned about the potential of a high-powered narcotic like OxyContin to be abused by patients or cause addiction.
As a result, company officials developed a fraudulent marketing campaign designed to promote OxyContin as a time-released drug that was less prone to such problems. OxyContin is made of a long-used narcotic, oxycodone. But unlike other medications like Percocet that also contain the narcotic, OxyContin is pure oxycodone and, because it is a time-released drug, contains it in very high doses. The drug is valuable in treating serious, long-lasting pain, but is being prescribed for moderate pain by a lot of doctors. http://www.nytimes.com/2007/12/28/us/politics/28oxycontin.html?pagewanted=1&_r=1&ei=5087&em&en=15071bb733ac6a63&ex=1198990800&adxnnlx=1198854326-gaGQ5LnxWKlI2wwT51as3g
Just a few years after the drug’s introduction in 1996, annual sales reached $1 billion. They told doctors Oxycontin was less addictive than other pain pills in the same category knowing full well the opposite was true. They targeted family practice doctors who had little experience treating people with severe pain or recognizing when their patients were addicted. Some of the sales people even made up fake graphs and charts. They created an epidemic of people who are unable to stop using this drug on their own. Not one of them went to jail even though there were criminal charges, with the help of Rudy Giuliani.

One of the things which is really bothering me about medicine right now is it’s denial about addiction. They call addiction from narcotics prescribed by a doctor physical dependence and claim this is different from addiction. We have been told all kinds raltionale such as people who have real pain do not get addicted. Of course they do. It may be a situation where it can't be helped and a patient has a very good reason to take the medication, but come on, addiction is addiction is addiction. I have to wonder which drug company paid for that idea to be disseminated in the medical community. They changed the name and made prescription medication caused addiction a whole different disease, which they would say I just can't understand.  Oh, I understand it intimately. It is a lot less litigiously risky for a doctor to tell a patient they have a dependence or tolerance than you are addicted now isn't it?

The truth is anyone can become addicted if they take a narcotic long enough. Narcotic use for pain management is a blessing in the appropriate patients with proper medical management. I do not advocate suffering. I have seen many people who narcotics have helped. What I am opposed to are the lies and manipulations to get people addicted to increase drug sales and make millions off of the suffering of thousands of people. They influence doctors to use narcotics when other choices would be better for the patient and society. We have a sick care system instead of a  health care system, there is little time to teach about or little reward for using non-narcotic methods of pain management. It is easier and cheaper to just give patients pain pills. I hoped for a health care system which changes this and a lot of other issues, but my hope is fading fast. If I had been told Stadol was highly addicting I would not have taken it in the early 90s. If my colleague had know Tramadol was a narcotic she would have taken Acetaminophen or Ibuprofen instead for her headache. Our addiction to narcotics has been engineered by the pharmaceutical industry. They did it with the intent of getting a captive group of consumers without regard for the suffering it has caused. Our regulating body the FDA has been complicit as well as politicians who are bought off and pass regulations making it easier for them to market these drugs to an unsuspecting country.

Sevostianova N, Danysz W, Bespalov AY. Analgesic effects of morphine and loperamide in the rat formalin test: Interactions with NMDA receptor antagonists. Eur J Pharmacol. 2005;525:83–90.
Menendez L, Lastra A, Meana A, Hidalgo A, Baamonde A. Analgesic effects of loperamide in bone cancer pain in mice. Pharmacol Biochem Behav. 2005;81:114–121.



Thanks for all you are doing. Your blog is great. I put an excerpt on BLOW-POP-PALIN4 if that is fine with you. Let me know.

You have so much information! I sure enjoyed Professor Irwin Corey. He had come to my mind, but I had not recalled his name until I say your post.

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Henry Pelifian said...

Great post on pharmaceutical industry! Frozen Justice is a title that increasingly applies to our system as a result of the "war on terror", but who cares?