YOU KNOW. THERE ARE DRUGS IN
THIS COUNTRY THAT ARE CLASSIFIED
AS LEGAL AND OTHER DRUGS THA ARE CLASSIFIED AS ILLEGAL.
AND FOR SOME PEOPLE. ALL I NEEDS TO BE LABELED IS LEGAL.
AND IF YOU HAVE A DOCTOR IN
PLACE. A DOCTOR'S AN AUTHORITY
FIGURE WHO HAS THE. YOU KNOW,
ABILITY TO PRESCRIBE DRUGS.
A LOT OF PEOPLE FEEL LIKE.
"WELL. IF A DOCTOR PRESCRIBED
IT. IT'S FINE."
BUT IF WE LOOK AT SOMEONE
LIKE MICHAEL JACKSON--WHO IS
PROBABLY THE MOST FAMOUS PERSON
ON THE PLANET AT THE TIME THA HE DIED--HE WAS GETTING DRUGS
SUCH AS PROPOFOL OR DIPRIVAN.
THIS IS A MEDICATION THAT IS
USED IN AN OPERATING ROOM.
SHOULD NEVER BE USED OUTSIDE OF
AN OPERATING ROOM.
BUT HE WAS TAKING PAIN PILLS.
HE WAS TAKING PILLS FOR ANXIETY.
PILLS FOR SLEEP.
AND IT'S SORT OF AN
INTERESTING QUESTION WHY--
YOU KNOW. ARE PRESCRIPTION DRUGS
LESS DANGEROUS THAN ALCOHOL
AND CIGARETTES?
SOMETIMES. BUT SOMETIMES NOT.
WE'VE TURNED THE CORNER ON
DRUG ADDICTION IN THE
UNITED STATES.
ONE OF THE MOST FAMOUS STARS
IN HOLLYWOOD HISTORY IS DEAD
AT 36.
MARILYN MONROE WAS FOUND DEAD IN
BED UNDER CIRCUMSTANCES THA WERE IN TRAGIC CONTRAST TO HER
GLAMOROUS CAREER AS A COMIC
TALENT.
I'M GONNA GET I 'CAUSE I'M A FIEND
SELL THE DEVIL MY SOUL
TO GET ME WHAT I NEED
GET ME A FIX
GET ME BACK INTO THE ZONE
I SAID. "WE NEED AN AMBULANCE
AT GRACELAND.
YOU SHOULD GET SOMEBODY
REAL QUICK."
RIGOR MORTIS HAD SET IN. AND SO
I TURNED HIM OVER REAL QUICK.
I PULLED UP HIS PAJAMA BOTTOMS.
AND HE WALKED IN. HE SAID,
"ELVIS IS GONE."
TRIPLED UP ON EVERYTHING
I'M NOT BREATHING RIGH IT'S GOT A HOLD ON ME
AND IT MIGHT SEIZE MY LIFE
FLOWERS. CANDLES, NOTES.
THESE ARE ITEMS FOUND LEF OUTSIDE OF THE MANHATTAN
APARTMENT WHERE THE BODY OF
OSCAR NOMINATED ACTOR
HEATH LEDGER WAS FOUND.
POLICE SAY PRESCRIPTION PILLS
WERE FOUND NEARBY.
AN AUTOPSY PERFORMED WEDNESDAY
WAS INCONCLUSIVE.
WELL. WE HAVE A--
A GENTLEMAN HERE THAT NEEDS
HELP. AND HE'S NOT BREATHING.
PRESCRIPTION DRUG ABUSE HAD
BEEN A PROBLEM FOR JACKSON FOR
YEARS.
JACKSON FAMILY ATTORNEY
BRIAN OXMAN TELLS US WEEKLY.
"I WARNED THEM.
THERE IS THE MISUSE OF
PRESCRIPTION MEDICATIONS BY
PEOPLE WHO WERE ENABLING HIM."
IT ALL REALLY STARTED IN 1972
WHEN RICHARD NIXON COINED THE
PHRASE "THE WAR ON DRUGS."
BUT IT'S PRETTY CLEAR AT THIS
POINT THAT WE HAVE LOST THA WAR. AND THAT WAR WAS REALLY
DEALING WITH ILLEGAL DRUG TRADE.
YOU GOT TO PUSH
IN MY HAND
THAT WON'T LET UP
HIGH STAKES
I'M GONNA GET I 'CAUSE I'M A FIEND
SELL THE DEVIL MY SOUL
TO GET ME WHAT I NEED
GET ME A FIX
GET ME BACK INTO THE ZONE
JUST ONE MORE TRIP
UNTIL MY MIND GETS BLOWN
LEAVE ME ALONE
PRESCRIPTIONS FOR
THE SHIT I'M ON
GOT ME LOOKING
LIKE THE LIGHT'S ON
BUT NO ONE'S HOME
CHECK MY HEARTBEA RACING AT THE SPEED OF LIGH PERCOCET OR VICODIN
WILL SET YOU FREE TONIGH [ applause ]
THANK YOU.
WHAT A GLORIOUS DAY.
FOR AMERICAN SENIORS. A STRONG
AND MODERN MEDICARE STARTS
TODAY.
IT TOOK A LOT OF WORK TO GET US
HERE. AND IT TOOK THE LEADERSHIP
OF PRESIDENT GEORGE W. BUSH.
[ applause ]
LAW ENFORCEMENT NOW.
AFTER 9/11. IS LOCKING DOWN THE
BORDERS AND FOCUSING ON
TERRORISM.
BUT WHEN YOU LOCK DOWN THE
BORDERS. WHAT'S NOT GETTING IN?
ALL OF THE ILLEGAL SUBSTANCES
THAT WERE COMING IN FROM OUT OF
STATE ARE SIGNIFICANTLY REDUCED.
SO LOOK AT THE STATISTICS.
AFTER 9/11. IT LOOKED LIKE WE
WERE WINNING THE WAR ON DRUGS.
BUT THE PROBLEM IS. NO ONE
ADDRESSED THE DRUG SEEKING
BEHAVIOR.
THE SUPPLY WAS REDUCED OF YOUR
STREET LEVEL DRUG. BUT THE
DEMAND WAS STILL THERE FOR THE
MISUSE OF DRUGS.
WHITNEY HOUSTON WAS
PRONOUNCED DEAD AT THE BEVERLY
HILTON HOTEL.
GREG GIRALDO. WHO DIED FROM
AN ACCIDENTAL OVERDOSE.
THE ACTRESS BRITTANY MURPHY.
SHE DIED VERY SUDDENLY.
LESLIE CARTER HAS DIED.
AND I WAS ADDICTED TO
OXYCONTIN AND OPANAS.
40 MILLIGRAMS.
TWO TIMES A DAY ALONG WITH
DILAUDID. 4 MILLIGRAMS SIX TIMES
A DAY.
I WAS TAKING NORCO.
I WAS TAKING ABOUT EIGHT A DAY.
CO. ANYWHERE FROM TWO TO--
EVERY TWO TO THREE HOURS.
ABOUT SIX TIMES A DAY.
NORCO. EIGHT A DAY.
AND PRETTY MUCH EVERY OTHER
OPIOID OR DANGEROUS NARCOTIC
THAT'S OUT THERE.
HE SAID HE HAD HURT HIS BACK
AND THAT HE WAS TAKING I BECAUSE HIS BACK WAS HURTING.
OXYCONTIN AND ROXICODONE
AND SOMAS.
ALL PRESCRIBED AT ONE TIME.
AND THIS DOCTOR WAS PRESCRIBING
HIM MEDICATION FOR AN ILLNESS HE
DIDN'T HAVE.
HE KIND OF LOST HIS--HIS DRIVE.
YOU WANT TO SAY.
AND I WENT TO WORK. AND ABOU PROBABLY. LIKE, 10:00--I DON' EVEN--THE DAY IS--THE DAY IS
JUST A MESS FOR ME.
I GET A CALL. AND IT'S MY MOM.
SHE SAYS. "SOMETHING'S WRONG
WITH JOSEPH.
I WENT TO WAKE HIM UP.
AND THERE'S THIS STUFF COMING
OUT OF HIS MOUTH."
AND I YELLED AT MY MOM.
I'M LIKE. "WHY ARE YOU CALLING
ME?
WHY AREN'T YOU CALLING THE--
YOU KNOW. THE PARAMEDICS OR
SOMETHING?"
AND I RAN OUT OF WORK.
I LEFT WORK. AND I PRAYED ALL
THE WAY HOME. TRIED TO BARGAIN
WITH GOD.
NO BARGAINING WITH GOD.
I GOT HERE.
NO PARAMEDICS.
ONLY POLICE.
AND SO HE WAS GONE.
AND FROM WHAT THE CORONER SAYS.
HIS--HE ONLY TOOK ONE PILL.
HE TOOK ONE PILL.
AND HIS BODY COULDN' HANDLE IT ANYMORE.
AND HE WENT TO SLEEP.
AND HE DIDN'T WAKE UP.
AND I GUESS THEY FOUND OUT THAT.
WELL. MAYBE IT WASN'T JUS MY SON.
MAYBE THERE'S OTHERS.
SO THEY STARTED DOING THEIR OWN
UNDERCOVER WORK.
THEY WENT IN THERE UNDERCOVER
AND HOW EASY IT IS TO WALK INTO
A DOCTOR'S OFFICE AND SAY YOUR
BACK HURTS. "MY NECK HURTS,
MY LEG HURTS."
AND GET A PRESCRIPTION FOR
A DRUG THAT IS REALLY FOR PEOPLE
WITH. LIKE, CANCER OR SOMETHING
THAT'S VERY--YOU KNOW. A VERY
SEVERE ILLNESS.
OKAY. MY NAME IS SERGEAN STEVE OPFERMAN FROM THE LOS
ANGELES COUNTY SHERIFF'S
DEPARTMENT.
I'M ASSIGNED TO OUR DETECTIVE
DIVISION. MAJOR CRIMES BUREAU.
I SUPERVISE A MULTI-AGENCY TASK
FORCE CALLED HALT. WHICH IS THE
HEALTH AUTHORITY LAW ENFORCEMEN TASK FORCE.
WE HANDLE OVER 100 CASES A YEAR.
WE CONFISCATE AND DESTROY
PROBABLY $3 MILLION TO
$5 MILLION WORTH OF CONFISCATED
DRUGS ANNUALLY.
WE'VE ESTIMATED WE'VE PROBABLY
SAVED THE GOVERNMENT BY
STOPPING. YOU KNOW, A LOT OF
THESE ILLEGAL BUSINESSES ABOU $50 MILLION IN MEDICARE
AND MEDI-CAL CLAIMS.
THIS IS AN EXAMPLE OF
MEDICATIONS THAT WE SEIZE FROM
WHAT WE CALL A CAPPER.
THIS IS A RECRUITER THAT WOULD
GO AROUND SKID ROW. AND, YOU
KNOW. FIND PEOPLE WITH MEDICARE
CARDS.
WHEN WE'RE TALKING ABOUT THE
NON-CONTROLLED SUBSTANCES.
WHEN WE'RE TALKING ABOU MEDICINES THEMSELVES.
THERE'S A DIFFERENT BLACK
MARKET.
BUT THE DRUGS ARE INITIALLY
ACQUIRED BY THE SAME MEANS.
THE MAIN FOCUS BY GOVERNMEN IS USUALLY ON SUPPLY.
IF WE REDUCE THE SUPPLY.
THAT REDUCES THE PROBLEM.
WELL. NOT TRUE.
IF YOU HAVE DRUG SEEKING
BEHAVIOR AND YOU REDUCE THE
SUPPLY. IT'S LIKE SQUEEZING THE
END OF A BALLOON.
IT JUST BLOWS UP SOMEWHERE ELSE.
AND YOU SEE THIS TREMENDOUSLY
WITH DRUGS. WHETHER IT'S ILLEGAL
DRUGS AND LEGAL DRUGS.
THE MODEL OF SORT OF OPTIMIZING
CONTROL AND PROFITS ON DRUGS IS.
TO ME. VERY MUCH ONE MODEL,
BECAUSE THE ECONOMICS OF BOTH
THE ILLEGAL AND THE LEGAL DRUGS
ARE VERY INTEGRAL FROM A--
FROM A POLICY AND GOVERNANCE
STANDPOINT.
I'M PLEASE THAT ALL OF YOU
ARE HERE TO WITNESS THE GREATES ADVANCE IN HEALTH CARE COVERAGE
FOR AMERICA'S SENIORS SINCE
THE FOUNDING OF MEDICARE.
[ applause ]
THIS SOCIAL PHENOMENA IS NOW
GROWING WITH THE MISUSE OF
PHARMACEUTICAL DRUGS.
EVERYBODY. INCLUDING THEIR
PARENTS. THEIR BROTHERS,
THEIR SISTERS. THEIR
GRANDPARENTS.
EVERYBODY'S POPPING PILLS.
I'M FEELING SHITTY NOW
MY PILLS ARE GONE
I DONE POPPED ALL MY VICODIN
THE OTHER DAY
NOW THAT MY MEDS ARE DONE
I'M PARANOID
BUT I'MA GET HIGH
IN SOME OTHER WAY
I'MA GET HIGH
IN SOME OTHER WAY
I GOT TO GET HIGH
TO GET THROUGH THE DAY
I'MA GET HIGH
TO GET THROUGH THE DAY
I'MA GET HIGH
GET HIGH
I'MA GET HIGH
GETTING IN IT NOW
PRESCRIPTION DRUG ABUSE IS
RISING IN ALL CATEGORIES IN THE
UNITED STATES AND ALL AGE
GROUPS. BUT UNFORTUNATELY,
12- TO 17-YEARS OLDS ARE
THE FASTEST GROWING SEGMENT OF
EVERYBODY GROWING FASTER IN
TERMS OF DRUG ABUSE--
PRESCRIPTION DRUG ABUSE.
THE STATE OF FLORIDA IS NOW
EXPERIENCING UP TO SEVEN
INDIVIDUALS A DAY DYING FROM THE
MISUSE AND THE ABUSE OF
PHARMACEUTICAL DRUGS.
WE HAVE THREE TIMES AS MANY
PEOPLE DIE EVERY YEAR FROM
PRESCRIPTION PILLS VERSUS
HEROIN. COCAINE,
AND METHAMPHETAMINE COMBINED.
THEY STARTED GOING TO
PHYSICIANS' OFFICES.
THEY STARTED GETTING DRUGS FROM
"LEGITIMATE SOURCES."
AND ALL OF A SUDDEN. YOU CAN SEE
THE INFLUX IN PAIN MANAGEMEN CLINICS.
YOU CAN SEE THE INFLUX
IN LEGALIZED DRUG DEALING.
BROWARD. WHICH IS THE FOR LAUDERDALE AREA. IS THE
EPICENTER OF THIS PILL MILL
EPIDEMIC.
AND WHAT WE SAW WAS THAT IN THE
FIRST SIX MONTHS OF 2008.
67% OF THE OXYCODONE NATIONWIDE
THAT WAS PUT OUT BY DISPENSING
PRACTITIONERS CAME OUT OF
BROWARD COUNTY. FLORIDA.
THE ENTIRE MID-EASTERN QUADRAN OF THE U.S.. ALL THOSE STATES
HAD A PRESCRIPTION DRUG
MONITORING PROGRAM.
WELL. WHAT THAT DID IS STARTED
TO DRIVE DRUG SEEKERS--AND I'M
NOT GONNA USE THE TERM PATIENT.
IT DROVE DRUG SEEKERS FROM THOSE
STATES INTO THE STATE OF
FLORIDA.
PRESCRIPTION DRUG ABUSE IS
RISING. BUT THE INNOCENT VICTIMS
ARE THE INFANTS BORN EXPOSED TO
OPIATES IN UTERO.
BROWARD COUNTY. FLORIDA,
HAS SEEN A QUADRUPLE INCREASE
AND MORE THAN HALF OF THE PEOPLE
TAKING PRESCRIPTION DRUGS ARE
WOMEN.
THEY'RE--OVER THE LAS SEVERAL YEARS THERE.
THERE'S BEEN NO REGULATION
WHATSOEVER IN TERMS OF PATIENTS
BEING ABLE TO GO TO DIFFEREN OFFICES AND GET PRESCRIPTION
PILLS. AND BECAUSE OF THAT,
YOU HAVE AN INFLUX OF PEOPLE
ACTUALLY COMING FROM OTHER
STATES TO GET THESE MEDICATIONS.
SO AS THE NUMBER OF ADULTS AND
WOMEN RISE TAKING THESE
PRESCRIPTION PILLS. IT'S NO
SURPRISE THAT THEY'RE HAVING
BABIES THAT ARE DEPENDENT ON
PAINKILLERS.
YEAH. THERE YOU GO,
OKAY. LOOK RIGHT THERE.
HE'S MAKING A BUY.
YEAH. HE'S MAKING THE BUY
WITH THE GUY IN THE BROWN.
HE'S GOT HIS MONEY IN HIS HAND.
HE'S SHOWING HIM SOMETHING.
THE DRUG DEALERS. WHEN THEY'RE
DEALING WITH PRESCRIPTION DRUGS.
GET THE INSURANCE COMPANIES.
MEDI-CAL OR MEDICAID.
THESE PROGRAMS PAY FOR THESE
DRUGS. AND THEN THEY'RE RESOLD.
IT STARTS WITH PEOPLE THAT WE
CALL CAPPERS THAT GENERALLY
DRIVE AROUND INDIGEN NEIGHBORHOODS. ANYWHERE WHERE
PEOPLE ARE RECEIVING GOVERNMEN BENEFITS. PRIMARILY MEDICARE.
THEY'RE USUALLY NEVER SEEN BY
A DOCTOR.
SOMEBODY IN THERE WILL WRITE
A PRESCRIPTION.
THEN THEY'LL PAY THAT PERSON TO
GO TO A PHARMACY AND FILL THA PRESCRIPTION. AND THEN THEY'LL
GIVE THOSE DRUGS BACK TO WHAT WE
CALL A CAPPER.
THEY WILL TAKE THOSE DRUGS TO
SOMEBODY THAT'S GENERALLY
INVOLVED IN ORGANIZED CRIME
HERE IN L.A.
THEY'LL TAKE THEM BACK TO RETAIL
PHARMACIES THAT THEY OWN.
THEY'LL TAKE THEM BACK TO WHA THEY CALL CLOSED-DOOR PHARMACIES
THAT THEY OWN. USE THAT AS PAR OF THEIR INVENTORY.
SO NOW THEY'RE ABLE TO BILL.
AGAIN. MEDICARE FOR PRESCRIBING
THESE DRUGS TO. SAY, AN ELDERLY
PATIENT IN A NURSING HOME.
THAT PERSON NEVER RECEIVES THOSE
DRUGS EVEN THOUGH THERE'S
A PAPER TRAIL AND A BILLING
TRAIL CREATED SO THEY CAN
CONTINUE BILLING.
THEN WHEN THOSE DRUGS EXPIRE.
THEY'RE GONNA PACKAGE THEM UP.
AND THEY'RE GONNA TAKE THEM TO
OUT OF STATE TO A WHOLESALE
REPACKAGING BUSINESS.
IF YOU AUTOMATE ALL THE
RECORDS IN THE STATE. ALL THE
CONTROLLED SUBSTANCE RECORDS.
AND A PHYSICIAN ACCESSES YOUR
FILE THROUGH THE PDMP. HE CAN
SEE WHATEVER PHYSICIANS YOU'VE
BEEN TO. WHAT QUANTITIES YOU'VE
BEEN PRESCRIBED.
AND IF HE'S CHECKING THE SYSTEM.
AND YOU'VE RECEIVED A CONTROLLED
SUBSTANCE FROM ANOTHER DOCTOR.
HE'S NOT GOING TO PRESCRIBE.
BECAUSE THAT'S A THREAT TO HIS
LICENSE.
THAT WOULD BE A LEGITIMATE
DOCTOR IDENTIFYING DRUG SEEKING
ACTIVITY.
SO OUR BILL. OUR ORIGINAL
BILL LAST YEAR WOULD'VE CHARGED
1/4 CENT PER PRESCRIPTION
DRUG--PILL. I SHOULD SAY--
TO GO INTO A FUND TO COLLEC A FEW MILLION DOLLARS SO THAT WE
COULD DEVELOP THE CAPACITY TO
GET EVERYONE WHO WRITES
PRESCRIPTIONS--175.000 PEOPLE
WHO ARE LEGALLY ABLE TO WRITE
PRESCRIPTIONS IN CALIFORNIA--
TO BE ELECTRONICALLY ON THIS
DATABASE.
SO IN REAL TIME. THE DEPARTMEN OF JUSTICE AND THE DOCTOR
PRESCRIBING THE DRUG CAN SEE
WHO'S PRESCRIBING WHAT DRUGS.
AND ON THE OTHER HAND. THE
DEPARTMENT OF JUSTICE CAN SEE
THAT IF THERE ARE PHYSICIANS OR
ANYONE WHO'S ALLOWED TO WRITE
PRESCRIPTIONS ARE ABUSING I AND BASICALLY TAKING THE TRUS THE PUBLIC PUTS IN THEM AS
PHYSICIANS AND ABUSING IT BY
MAKING PROFIT MONEY BY SELLING
OPIATES. PAINKILLERS TO PEOPLE.
THEY FOUND A PRESCRIPTION
RECEIPT IN HIS CAR. AND I GUESS
THE CORONER CALLED THE DOCTOR
AND ASKED HIM. "WHAT DID YOU
GIVE THIS BOY?
WHAT DID YOU GIVE THIS BOY?"
THE DOCTOR SAID. "WELL, WHY?"
HE'S LIKE. "BECAUSE HE'S DEAD.
HE'S DEAD.
HE'S 25 YEARS OLD. AND HE'S
DEAD."
THEN HE TOLD HIM WHAT HE
PRESCRIBED TO HIM. AND IT WAS
THE ROXI--NO. OXYCONTIN.
IT'S--THE FORM OF IT WAS THE
KIND THAT DOES NOT--IT DOESN' TIME RELEASE OR SOMETHING LIKE
THAT.
IT'S JUST INSTANTANEOUS PAIN
RELIEF.
SO SYSTEMATICALLY FROM 2001
UP TO APPROXIMATELY 2009.
THE STATE OF FLORIDA FOUGHT FOR
A PDMP IN THE LEGISLATURE.
BILLS WERE INTRODUCED. AND I WAS FOUGHT DOWN EVERY YEAR.
PURDUE PHARMA ALSO STEPPED UP TO
THE PLATE AND MOST RECENTLY.
AS OF A WEEK AGO.
OFFERED $1 MILLION TO SUPPOR THE STATE OF FLORIDA IN A PDMP
PROGRAM AND TO PAY FOR THE PDMP
PROGRAM FOR THE STATE OF
FLORIDA.
AND THIS IS WHERE POLITICS COMES
INTO PLAY.
THE GOVERNOR OF THE STATE OF
FLORIDA DECLINED AND DOES NO SEE FIT THAT A PDMP BE
IMPLEMENTED WITHIN THE STATE OF
FLORIDA.
HE CITES THAT IT'S A VIOLATION
OF PRIVACY.
I MET WITH THE PHARMACEUTICAL
INDUSTRY.
I WAS RIGHT UPFRONT WITH THEM.
I TOLD THEM. "THIS IS WHAT I
WANT TO DO.
IT SEEMS TO ME IT'S IN YOUR BES INTEREST TO HELP US DO THIS.
IT'S NOT IN YOUR BEST INTERES TO READ ABOUT PEOPLE DYING FROM
ABUSE OF YOUR LEGAL PRODUCT."
AND WE HAD SOME GOOD MEETINGS.
BUT WHEN THE BILL ACTUALLY WEN TO COMMITTEE AND. OBVIOUSLY,
HAD TO GET PASSED OUT OF
COMMITTEE IN A MAJORITY VOTE TO
GET HERE TO THE FLOOR OF THE
SENATE. I COULDN'T DO IT.
I COULDN'T DO IT TWICE.
THE FIRST TIME. I CAME OUT OF
THE HEARING ROOM. AND I COULD
SEE SOME LOBBYIST TALKING WITH
A COUPLE OF MY COLLEAGUES.
AND THESE ARE DEMOCRATIC
COLLEAGUES WHO I THOUGHT I HAD
THEIR VOTE.
AND WHEN THE ROLL CALL WAS
TAKEN. I DIDN'T HAVE THEIR VOTE.
IF WE ARE SEEING RAPID
ACCELERATION OF PRESCRIPTION
DRUGS THAT ARE BEING GIVEN TO
MORE AND MORE AND MORE PEOPLE.
INCLUDING CHILDREN.
OVER THE YEARS IN THE FUTURE.
WE ARE ALSO LOOKING A A CORRESPONDING INCREASE
OF DIAGNOSES BY DOCTORS.
WHAT WAS ONCE A DIAGNOSTIC
MANUAL THAT WAS PAPER THIN IS
NOW A HUGE BOOK WITH HUNDREDS OF
DIAGNOSES IN IT THAT GROWS AND
GROWS AND GROWS.
TO THE POINT WHERE PEOPLE ARE
BEING SLICED AND DICED.
WHERE THERE IS NOTHING WRONG
WITH THE PERSON. BUT SOMETHING
IS BEING SAID TO BE WRONG WITH
THAT PERSON.
IT GETS INTO THAT AREA.
IN THIS COUNTRY. WE HAVE
CREATED ILLNESSES FOR DRUGS.
SO IN OTHER WORDS. I'VE SEEN--
YOU SEE--PEOPLE HAVE SEEN THE
COMMERCIAL. RESTLESS LEG
SYNDROME.
MOST PEOPLE HAD NEVER HEARD OF
THAT.
BUT ONCE THAT COMMERCIAL STARTED
PLAYING. THE NUMBER OF DIAGNOSES
FOR RESTLESS LEG SYNDROME WEN THROUGH THE ROOF.
FORTUNATELY. THERE'S MIRAPEX.
MIRAPEX IS A PRESCRIPTION
MEDICINE THAT HELPS RELIEVE THE
FREQUENCY AND SEVERITY OF MANY
RLS SYMPTOMS.
JUST RECENTLY. I SAW
A COMMERCIAL WHERE THERE IS
A GUY. MID-40s, EARLY 50s,
AND THE NARRATOR IS LIKE.
"YOU CAN'T HIT THE GOLF BALL AS
FAR AS YOU USED TO.
YOU DON'T HAVE THE ENERGY LEVEL
YOU'RE USED TO.
YOU'RE NOT THE SAME GUY YOU WERE
IN THE BEDROOM."
AND IT SAYS. "MAYBE YOU'RE
SUFFERING FROM LOW 'T.'"
AND THEN I'M LIKE. "WHAT IS LOW
'T'?"
AND THEN BEFORE I CAN EVEN SAY
THAT TO MYSELF. THE ANNOUNCER
SAYS. "LOW 'T' IS LOW
TESTOSTERONE."
TESTOSTERONE LEVELS DROP
NORMALLY IN MEN AS THEY GE OLDER.
IT'S NOT NECESSARILY A PROBLEM.
BUT THEY'RE CREATING A PROBLEM.
BECAUSE THERE IS NOW A NEW
TREATMENT. A NEW PILL FOR IT.
CRITICS. ANYWAY,
OF DIRECT-TO-CONSUMER
ADVERTISING SAY THAT IT LEADS TO
A LOT OF PROBLEMS. THAT IT,
NUMBER ONE. OVERMEDICALIZES
THINGS IN SOCIETY THAT ARE
REALLY NOT MEDICAL PROBLEMS.
LIKE. AN EXAMPLE OF THAT IS
ANXIETY.
SO SOCIAL ANXIETY SYNDROME.
ANOTHER EXAMPLE IS PREMENSTRUAL
SYMPTOMS.
MY DOCTOR TOLD ME.
"THAT'S NOT PMS; THAT'S PMDD."
UNLIKE PMS. SYMPTOMS OF PMDD
ARE SEVERE ENOUGH TO ACTUALLY
INTERFERE WITH YOUR LIFE.
THINGS LIKE THIS THAT ARE KIND
OF NORMAL FOR HUMANS ARE TURNED
INTO A DISEASE. AND PEOPLE
SUBSEQUENTLY REQUEST MEDICATION
TREATMENT FOR THESE THINGS THA MAY NOT EVEN BE A DISEASE
AT ALL.
SO THAT'S BEEN A CRITICISM OF
DIRECT-TO-CONSUMER ADVERTISING.
ATTENTION YAZ. YASMIN,
AND OCELLA USERS. THE FDA SAYS
THESE DRUGS MAY CAUSE BLOOD
CLOTS AND SERIOUS HEART AND
HEALTH PROBLEMS.
THERE ARE A LOT OF
DIRECT-TO-CONSUMER
ADVERTISEMENTS OF
ANTI-DEPRESSANTS. AND TYPICALLY,
PEOPLE WILL COME IN IF THEY'RE
DEPRESSED. ASKING FOR THOSE
PARTICULAR DRUGS AS OPPOSED TO
OLDER ALTERNATIVES.
AND INTERESTINGLY. ONE OF THE
DRUGS THAT IS CURRENTLY BEING
MARKETED FOR DEPRESSION IS
ACTUALLY A DRUG THAT'S USED FOR
PSYCHOSIS. FOR THINGS LIKE
SCHIZOPHRENIA. BUT THAT IT--
IT IS USEFUL AS AN ADJUNCT TO
DEPRESSION MEDICINES IN CASES OF
VERY SEVERE DEPRESSION.
AND WE SAW A LOT OF ADS.
IN OUR REVIEW OF
DIRECT-TO-CONSUMER
ADVERTISEMENTS WE SAW A LOT OF
ADS FOR THIS PARTICULAR DRUG.
AND I HAVE HAD A LOT OF PATIENTS
ASKING ME FOR IT. EVEN THOUGH I IS ACTUALLY COMPLETELY
INAPPROPRIATE.
ABILIFY TREATS DEPRESSION IN
ADULTS WHEN ADDED TO AN
ANTI-DEPRESSANT.
SOME PEOPLE HAD SYMPTOM
IMPROVEMENT IN AS EARLY
AS ONE TO TWO WEEKS.
ADDING ABILIFY HAS MADE
A DIFFERENCE FOR ME.
I MEAN. THE ADS DON'T SAY
THAT IT'S A FIRST LINE AGENT FOR
DEPRESSION. BUT BECAUSE IT'S
ADVERTISED AND THE PEOPLE IN THE
ADS LOOK HAPPY. YOU KNOW,
PATIENTS WHO ARE DEPRESSED WAN A DRUG THAT'S GONNA MAKE THEM
HAPPY TOO.
AND IT'S BEEN VERY INTERESTING.
PEOPLE ARE ASKING FOR THIS DRUG
THAT THEY REALLY DON'T WANT TO
TAKE.
THE MOST SUCCESSFUL PR
CAMPAIGN IN THE HISTORY OF THE
WORLD WAS ELI LILLY PR-ING THA DEPRESSION IS CAUSED BY
A BIOCHEMICAL IMBALANCE AND THA PROZAC COULD FIX IT.
THERE WAS SOME INTERESTING
RESEARCH DONE LOOKING AT THE
GROUP FOR THE DIAGNOSTIC MANUAL
THAT MADE UP THE DIAGNOSES FOR
PSYCHOSES AND FOR MOOD
DISORDERS. WHICH ARE SOME OF THE
MAIN PLACES THAT THE DRUG
COMPANIES MAKE MONEY FROM.
AND EVERY SINGLE MEMBER OF THE
PSYCHIATRIC ASSOCIATION'S
COMMITTEE WAS INVOLVED WITH DRUG
COMPANIES. GETTING MONEY FROM
DRUG COMPANIES. ALL OF THEM.
ABOUT SIX YEARS AGO.
MY FATHER PASSED AWAY.
MY PARENTS HAD BEEN MARRIED OVER
45 YEARS. AND MY MOM--
VERY HEALTHY. IN HER 70s,
ON NO MEDICATIONS--WENT TO HER
DOCTOR FOR REGULAR CHECKUP.
AND THE DOCTOR LOOKED AT HER
AND SAID. "YOU KNOW, MISS SMITH,
YOU JUST DON'T LOOK LIKE YOUR
USUAL SELF." AND SHE WENT AHEAD
AND TOLD THE DOCTOR. "WELL, MY
HUSBAND OF 45. 50 YEARS JUS PASSED AWAY."
SO BEFORE MY MOM COULD EVEN
FINISH SAYING ANYTHING. HE WAS
WRITING OUT A PRESCRIPTION.
SO HE HANDED HER A PRESCRIPTION.
AND MY MOM SAID. "WHAT IS THIS?"
AND HE SAID. "IT'S PROZAC FOR
DEPRESSION."
AND MY MOM LOOKED AT HIM AND
SAID. "I'M NOT DEPRESSED.
I'M JUST SAD."
AND I THINK THIS IS REALLY
A MICROCOSM OF WHAT IS GOING ON
IN THIS COUNTRY AT THIS TIME.
PEOPLE HAVE A PROBLEM.
AND INSTEAD OF ASKING THEM.
"WHAT IS THE PROBLEM."
HERE'S A PILL FOR IT.
NOW. THINK ABOUT HOW BIZARRE
IT IS TO SUM UP A PERSON'S LIFE
STRUGGLE WITH A DIAGNOSIS LIKE
BI-POLAR DISORDER.
THINK ABOUT LINCOLN.
THERE HAVE BEEN INNUMERABLE
BOOKS STUDYING LINCOLN. TRYING
TO FIGURE OUT WHO WAS LINCOLN.
WHAT MADE LINCOLN TICK.
BUT A PSYCHIATRIST SAYS
BIPOLAR DISORDER.
IT USED TO BE THAT A YOUNG
SOPHOMORE IN COLLEGE STRUGGLING
WITH HIS ANGST AND HIS SADNESS
AND HIS DEPRESSION WOULD READ
KIERKEGAARD OR READ SOME OTHER
REALLY DEEP AND BROODING BOOK TO
FIND SOME SOLUTIONS TO LIFE.
OR HE'D STUDY PHILOSOPHY.
MAYBE READ SOME FREUD.
MAYBE GET SOME THERAPY.
BUT HE'D VIEW HIMSELF OR HERSELF
AS STRUGGLING WITH LIFE ISSUES.
NOW THAT SAME COLLEGE SOPHOMORE
HAS ALREADY READ IN TEXTBOOKS
THAT ALL THE ANGUISH THAT PEOPLE
FEEL IS ABOUT BIOCHEMICAL
IMBALANCES.
AND WITH THAT. ALL THE LEARNING
OF WESTERN CIVILIZATION IS
THROWN OUT.
PEOPLE ARE ADDICTED TO THE
IDEA OF DRUGS.
THERE'S LOTS OF ADDICTION.
THEY BELIEVE THAT DRUGS WILL
HELP THEM.
PEOPLE ARE OVERUSING THIS
THING. THESE PRODUCTS THAT WERE
CREATED TO EASE THEIR PAIN.
AND IT'S CREATING MORE PAIN.
I MEAN. THAT'S THE IRONY OF--
AND THAT'S--AND EVERYTHING
ENDEMIC IN OUR CULTURE IS LIKE.
"WELL. GET RID OF MY PAIN,"
YOU KNOW?
"JUST GET RID OF IT.
I'LL PAY ANYTHING FOR IT."
BUT IT'S NOT GETTING RID OF
ANYTHING.
IT'S MAKING THINGS WORSE.
THIS IS AN OUTRAGEOUS
SOCIETAL PHENOMENON.
AND IT INDICATES A CULTURE
LOSING TOUCH WITH EMPATHY FOR
ITSELF AS INDIVIDUALS AND
EMPATHY FOR OTHER HUMAN BEINGS.
A CULTURE THAT HAS JUST GOTTEN
CAUGHT UP IN THE END PRODUC AND EFFICIENCY AND WORK AND NO AT ALL THINKING ABOUT.
"WHAT IS LIFE ABOUT?
WHO AM I?
WHO ARE MY CHILDREN?
ARE MY CHILDREN GIFTS FROM GOD?
ARE THEY TO BE TREASURED?
DO THEY REQUIRE THAT I CHANGE MY
LIFE TO BRING THEM UP BETTER?
OR ARE THEY OBJECTS TO BE
TINKERED WITH AND GIVEN DRUGS?"
TALKING WITH MY DOCTOR.
HE DIAGNOSED ME WITH ADHD.
AND I TOLD HIM AT THAT POIN THAT MY CHILDREN WERE TAKING
CONCERTA.
I SAID. YOU KNOW, "IS THERE
REASON TO THINK THAT IT WOULD
WORK FOR ME?"
AND HE SAID. "ABSOLUTELY."
AND I'LL PROBABLY
NEVER CHANGE
THE MORE I TRY
THE MORE I STAY THE SAME
I HATE TO LOOK IN THE MIRROR
'CAUSE ALL I SEE
SOMEBODY SPRUNG
THAT LOOKS ME
I HATE TO LOOK IN THE MIRROR
'CAUSE ALL I SEE
SOMEBODY SPRUNG
THAT LOOKS LIKE ME
AND I CAN'T BREAK MY HABITS
I'M AN AMERICAN ADDIC THE POINT MAN IN MY
ADMINISTRATION ON THIS ISSUE WAS
SECRETARY TOMMY THOMPSON.
AND HE AND HIS TEAM DID A
FABULOUS JOB OF WORKING WITH THE
CONGRESS TO GET THIS IMPORTAN PIECE OF LEGISLATION PASSED.
TOMMY. I WANT TO THANK YOU FOR
YOUR LEADERSHIP.
THIS BILL PASSED THE CONGRESS
BECAUSE OF THE STRONG LEADERSHIP
OF A HANDFUL OF MEMBERS.
STARTING WITH THE SPEAKER OF
THE HOUSE. DENNIS HASTERT.
[ applause ]
THE SPEAKER WAS JOINED BY
SENATOR BILL FRIST. SENATE
MAJORITY LEADER OF THE SENATE IN
PROVIDING THE LEADERSHIP
NECESSARY TO GET THIS BILL DONE.
I WANT TO THANK YOU BOTH.
[ applause ]
I APPRECIATE THE HARD WORK OF
THE HOUSE MAJORITY LEADER
TOM DELAY TO SEE THAT THIS BILL
WAS PASSED.
COMMITTEE CHAIRMAN BILL THOMAS
FOR HIS GOOD WORK.
[ applause ]
SENATOR CHUCK GRASSLEY DID
A NOBLE JOB.
SENATOR MAX BAUCUS OF MONTANA.
[ applause ]
AND SENATOR JOHN BREAUX.
[ applause ]
BILLY TAUZIN OF THE HOUSE OF
REPRESENTATIVES DID GREAT WORK
ON THIS BILL.
[ applause ]
SENATOR ORRIN HATCH FROM UTAH
MADE A SIGNIFICANT CONTRIBUTION.
NANCY JOHNSON. THE HOUSE MEMBER
FROM CONNECTICUT DID A GREA JOB.
[ applause ]
MIKE BILIRAKIS FROM FLORIDA
WORKED HARD ON THIS PIECE OF
LEGISLATION.
[ applause ]
I WANT TO THANK ALL THE OTHER
MEMBERS OF THE CONGRESS AND THE
SENATE WHO HAVE JOINED US.
THANK YOU ALL FOR TAKING TIME
OUT OF YOUR BUSY SCHEDULES TO
SHARE IN THIS HISTORIC MOMENT.
[ applause ]
THE BUSH ADMINISTRATION DID
MEDICARE PART D TO HELP THE
ELDERLY. ALL RIGHT.
THE ELDERLY OWNERS IN THE
PHARMACEUTICAL INDUSTRY.
THE PEOPLE WHO ARE THE CEOs.
THE PEOPLE WHO ARE THE MAJOR
STOCKHOLDERS.
WHEN I WORKED ON WALL STREE OR WHEN I WORKED IN WASHINGTON.
WE WOULD NEVER ASK THE QUESTION
ON HOW DO WE MAKE MONEY ON
SOMETHING SO MUCH AS THE
QUESTION WOULD BE ASKED.
"WHERE DO WE WANT THE WORLD TO
GO AND THEN HOW DO WE ENGINEER
THINGS SO THAT IT WILL GO THA WAY.
I LEFT WALL STREET. AND I WEN TO WASHINGTON. AND THEN I LEF WASHINGTON AND MOVED TO
TENNESSEE. AND ONE OF THE THINGS
I STRUGGLED THE MOST WITH WAS
EXPLAINING TO MY FAMILY AND
FRIENDS HOW THE ECONOMIC MODEL
THAT AMERICA WORKS ON REALLY
WORKS.
AND I FINALLY--I FINALLY DECIDED
TO WRITE A CASE STUDY.
IT'S CALLED DILLON READ AND THE
ARISTOCRACY OF STOCK PROFITS.
AND IT TELLS THE STORY OF HOW
WALL STREET MADE MONEY ON
HELPING FINANCING PRIVATE
PRISONS.
AND I--I WROTE IT BECAUSE I
WANTED PEOPLE TO UNDERSTAND THA A VERY FUNDAMENTALLY
NON-ECONOMIC ACTIVITY CAN BECOME
VERY PROFITABLE FOR MANY PEOPLE.
WHAT MEDICARE PART D DID WAS.
IT GAVE THE DRUG COMPANIES THE
ABILITY TO NAME THEIR PRICE FOR
PHARMACEUTICALS AND TO GET I AND TO HAVE THE GOVERNMEN PAY FOR IT.
WHAT YOU'LL OFTEN SEE IS SOR OF A COMBINATION OF AN INDUSTRY
MAKING MONEY AND GOVERNMEN ENGINEERING THE INCENTIVES AND
THE ECONOMICS SO THAT. WHETHER
IT'S THE CONSUMER OR THE
TAXPAYER. THEY ALSO MAKE MONEY
GOING IN THAT DIRECTION.
NOW. THIS IS AN INDUSTRY,
FROM MY UNDERSTANDING AND FROM
SOME AMOUNT OF RESEARCH. THA HAS REALLY CHANGED IN THE LAS 20 YEARS.
AT LEAST PEOPLE WILL OPINE THA THERE ARE VENTURE CAPITALISTS
WHO DID A GOOD DEAL OF RESEARCH
TO SEE WHO AMERICANS TRUSTED.
AND AMERICANS USED TO AND STILL
DO PUT A LOT OF TRUST IN PEOPLE
IN WHITE SMOCKS. PHARMACISTS,
DOCTORS--AS THEY SHOULD--
AND IN PHARMACEUTICAL COMPANIES.
UNFORTUNATELY. IN MY OPINION,
LIKE A LOT OF THINGS IN THE
INVESTMENT WORLD. THERE WERE
PEOPLE WHO WENT IN AND TOOK
COMPANIES OVER AND WHA COMPANIES USED TO PRIDE
THEMSELVES ON RESEARCH
AND DEVELOPMENT AND PROVIDING
A PRODUCT TO THE UNITED STATES
PUBLIC THAT WOULD LENGTHEN YOUR
LIVES AND MAKE THEM HEALTHIER
LIVES SOMEWHAT GOT CORRUPTED
AND GOT DRIVEN MORE ABOU PROFITABILITY. RETURN ON
INVESTMENT.
IF YOU LOOK AT THE AMOUNT OF
MONEY THEY SPEND ON LOBBYING IN
THE LAST CYCLE. IT WAS ABOU $272 MILLION.
I MEAN. THEY HAVE MORE LOBBYISTS
ACTIVE THAN THERE ARE MEMBERS OF
CONGRESS.
THERE'S $64 BILLION IN PROFITS
LAST YEAR. AND THAT'S ON
REVENUES OF ABOUT $254 BILLION
FOR THE TOP 12 PHARMACEUTICAL
COMPANIES.
SO YOU'RE TALKING ABOUT AN
ENORMOUS ECONOMIC IMPACT. AN
EXTRAORDINARY LOBBYING IMPACT.
AND A REAL POLITICAL IMPACT.
WE HAVE SOMETHING IN THIS
COUNTRY CALL A MEDICAL CARTEL.
A CARTEL IS BASICALLY
INTERLOCKING INTERESTS THAT FORM
EITHER A MONOPOLY OR SOMETHING
CLOSE TO MONOPOLY.
WE'RE TALKING ABOUT COMPANIES.
CORPORATIONS.
IN THIS CASE. WE'RE TALKING
ABOUT PHARMACEUTICAL COMPANIES.
MEDICAL SCHOOLS. GOVERNMEN AGENCIES LIKE THE FDA.
AND I WENT BACK TO HARVARD
FOR MY FIRST YEAR OF RESIDENCY
RIGHT AT THE TIME THAT THE
POLITICS OF PSYCHIATRY WAS
CHANGING.
WHEN I INTERVIEWED FOR HARVARD.
I WAS INTERVIEWED BY A FAMILY
THERAPIST. AND I MET PEOPLE WHO
WERE DOING FAMILY THERAPY AND
PSYCHOANALYSIS AND SOCIAL
THERAPIES.
ONE YEAR LATER. THE PROGRAM HAD
CHANGED INTO A BIOLOGICAL
PSYCHIATRIC PROGRAM WHERE YOU
HAD LIMITED TIME WITH YOUR
PATIENTS AND SPENT MOST OF YOUR
TIME DOING MEDICATION. MANAGING
WARDS. GIVING ECT.
THIS TRANSFORMATION WAS NO THROUGH SCIENCE.
THIS WAS A DECISION BY POLITICAL
PSYCHIATRY THAT THE FUTURE WAS
WITH SELLING BIOLOGY AND DRUGS
AS THE SOLUTION TO HUMAN
SUFFERING IF PSYCHIATRY WAS
GONNA KEEP ITS POWER
AND ITS STATUS.
WELL. ORIGINALLY, MODERN
MEDICAL SCHOOLS WERE MAINLY
FUNDED BY HUGE MEDICAL
NON-PROFIT FOUNDATIONS.
THOSE FOUNDATIONS HAD
A PARTICULAR VIEW OF MEDICINE
THAT WAS LEANING TOWARD WHAT HAS
BECOME MODERN PHARMACEUTICAL
MEDICINE.
AND SO TO HONOR THESE GRANTS.
THE MEDICAL SCHOOLS WERE FUNDED
AND EVEN ESTABLISHED TO TEACH
THAT BRAND OF MEDICINE.
MANY PEOPLE. WHEN THEY LOOK
AT A UNIVERSITY.
SEE A UNIVERSITY. SEE A SCHOOL.
THAT'S NOT WHAT I SEE.
I SEE AN ENDOWMENT. AND A LOT OF
INTERGENERATIONAL CAPITAL THA FINANCES CORPORATIONS IS
SHELTERED FROM TAXES BY MANAGING
IT THROUGH ENDOWMENTS. OFTEN FOR
UNIVERSITIES.
SO EVERYWHERE YOU GO. THERE'S
THE PSYCHOPHARMACEUTICAL
COMPLEX. AND ITS TENTACLES REACH
DEEPLY DOWN INTO OUR EDUCATIONAL
SYSTEM.
WE--WE NOW HAVE A SITUATION
WHERE THE DRUG COMPANIES ARE
SPONSORING PROGRAMS TO GO INTO
OUR SCHOOLS TO MONITOR OUR KIDS
AND FIND OUT WHO MAY BE HAVING
A PROBLEM. SO THAT THEY CAN BE
EVALUATED PSYCHIATRICALLY AND
SENT OFF TO CLINICS WHERE.
GUESS WHAT THEY'LL GET?
PILLS.
PEOPLE WILL BE MUCH LESS
PRONE TO SLIP THROUGH THE
CRACKS. BECAUSE WE HAVE FORCES
OPERATING ON THE FAMILY. ON THE
SCHOOLS. THE WORKPLACE,
TO GUARANTEE. IN A SENSE,
THAT THE OVERMEDICALIZATION OF
SOCIETY TAKES PLACE.
THE GOVERNMENT MONEY AND THE
GOVERNMENT RULES AND REGULATIONS
PROGRAM TO DEVELOP THE MODEL
WHERE THEY WANT TO GO.
SO. FOR EXAMPLE, WHEN I FIRS MOVED TO TENNESSEE. I HAD A
FRIEND WHO HAD JUST RETIRED FROM
TEACHING.
AND SO MANY PARENTS WOULD LOBBY
HER TO PUT HER--TO SAY THAT THE
CHILDREN NEEDED RITALIN. AND THE
REASON WAS. IF THEY GOT THE KIDS
ON RITALIN. THEY COULD GE A DISABILITY PAYMENT FROM SOCIAL
SECURITY.
IT WAS AN OVERNIGH TRANSFORMATION AT HARVARD.
BECAUSE HARVARD WAS CUTTING
EDGE.
AND IN PSYCHIATRY. WE SEE THIS
PHENOMENA THAT THE BEST IS THE
WORST. THAT THE MOST CUTTING
EDGE PSYCHIATRY. LIKE HARVARD TO
THIS DAY. IS THE PSYCHIATRY THA TAKES THE MOST MONEY FROM THE
DRUG COMPANIES. THAT HAS THE
MOST INTIMATE RELATIONSHIPS WITH
THE FEDERAL GOVERNMENT.
BUT THERE'LL BE SOMEONE A A MEDICAL SCHOOL TEACHING
MEDICAL SCHOOL STUDENTS.
TEACHING RESIDENTS. BU POCKETING $50.000
OR $100.000 A YEAR FOR BEING A
CONSULTANT TO THE DRUG COMPANY
AND GIVING TALKS.
WELL. THEY'RE NOT GONNA BE
A CONSULTANT AND THEY'RE NO GONNA GET PAID TO GIVE TALKS
UNLESS THEY ARE KNOWN TO BE
FAVORABLE TO THAT COMPANY
AND ITS PRODUCT.
SO THAT THERE ARE A NUMBER OF
PEOPLE IN ACADEMIC MEDICINE.
DOING TEACHING.
BEING "PRESTIGIOUS."
WHO ARE INFLUENCED BY THE VAS AMOUNTS OF MONEY THAT THEY THINK
THEY NEED TO GET FROM THE DRUG
INDUSTRY.
FOR EXAMPLE. AT HARVARD,
IT'S JOSEPH BIEDERMAN WHO
PERSONALLY CAUSED A REVOLUTION
IN THE TREATMENT OF CHILDREN BY
DEFINING MORE AND MORE CHILDREN
AS BIPOLAR SO THAT THESE KIDS
WOULD BE GIVEN PSYCHIATRIC DRUGS
THAT WERE SUITABLE ONLY FOR
ADULTS LIKE LITHIUM AND ABILIFY
AND SEROQUEL.
PILLS. PILLS, PILLS FOR CHILDREN
IS THE THEME THAT COMES OUT OF
THE HARVARD PSYCHOPHARMACOLOGY
PROGRAM.
I BLEW THE WHISTLE ON BIEDERMAN
YEARS AGO AS SOMEONE GETTING
HUGE MONEY FROM THE DRUG
COMPANIES. BUT IT TOOK A WHILE
FOR THE WHISTLE TO REACH
WASHINGTON. AND NOW THERE HAVE
BEEN HEARINGS. AND IT'S BEEN
DISCOVERED THAT JOSEPH BIEDERMAN
WAS GETTING A LOT MORE MONEY
THAN HE ADMITTED FROM THE DRUG
COMPANIES TO PUSH DRUGS ON
AMERICA'S CHILDREN.
THERE WAS A PROFESSOR A HARVARD LAST YEAR WHO HAD GOTTEN
MORE THAN $100.000 IN THE
PREVIOUS YEAR FROM THE DRUG
INDUSTRY. AND HARVARD INSTITUTED
A RULE THAT SAYS YOU CAN'T BE IN
THE FACULTY AND GET THAT KIND OF
MONEY FROM THE DRUG INDUSTRY.
SO HE SAID. "I WANT MY $100,000.
SO I'M LEAVING THE HARVARD
FACULTY.
I WENT ONTO THE NATIONAL
INSTITUTE OF MENTAL HEALTH.
SPENT TWO YEARS THERE. AND I WAS
THERE AS THE TRANSFORMATION WAS
HITTING NIMH.
WHEN I ARRIVED. THE NATIONAL
INSTITUTE OF MENTAL HEALTH WAS
BASICALLY A PSYCHOSOCIALLY
ORIENTED INSTITUTION IN 1966
AND '68.
BUT IT WAS THE BEGINNING OF THE
TRANSFORMATION OF NIMH INTO AN
ARM OF THE DRUG COMPANIES.
WE WOULD LATER DISCOVER THAT THE
DRUG COMPANIES ACTUALLY HAD
CONDUITS FOR GIVING MONEY TO
NIMH TO DO RESEARCH ON THE DRUG
COMPANIES' DRUGS.
IT'S ALL VERY. VERY INTIMATE
AND TIED TOGETHER.
THE PROFESSION WAS MOVING
HELL-BENT TO BEING LITERALLY AN
ARM OF THE DRUG COMPANIES.
WHY HAVE REGULATORY AGENCIES
BEEN CO-OPTED BY VESTED
INTERESTS THAT IS MOSTLY
INDUSTRY INTERESTS?
AND THAT'S BECAUSE THE INDUSTRY
IS--IS EVER-PRESENT.
I DON'T HAVE TO DOCUMENT THE
FACT THAT INDUSTRY LOBBYISTS
LOBBY CONGRESS EVERY DAY AND
VERY POWERFULLY. AND THEY GIVE
MONEY TO CAMPAIGNS.
IN TURN. CONGRESSPEOPLE
INFLUENCE THE REGULATORY
AGENCIES.
I THINK WHEN YOU HAVE PEOPLE
THAT ARE LOBBYING THAT HAVE A
LOT OF MONEY THAT THEY CAN THROW
AROUND. THEY GET FACE TIME,
AND THAT'S IMPORTANT.
THEY GET FACE TIME WITH THE
DECISION MAKERS. BECAUSE THEY'RE
ABLE TO DO CERTAIN THINGS FROM
A FINANCIAL STANDPOINT.
THE CONGRESS HAS. SEEMINGLY
REFLECTING THE PUBLIC INTEREST--
ALTHOUGH I'M NOT SURE THE PUBLIC
HAS REALLY WEIGHED IN ON IT--
DECIDING TO UNDERFUND THE FDA.
LEAVING THE FDA AT THE MERCY OF
INDUSTRY FUNDING SO THA COMPANIES PAY LARGE FEES LIKE
$1/4 MILLION--THAT'S--
WHEN I SAY A FEE. I MEAN A LO OF MONEY FOR THE--FOR THE
REGULATOR TO REVIEW ITS OWN
DRUG. WHICH IS A BALD CONFLIC OF INTEREST.
I MEAN. THE DRUG INDUSTRY HAS
GREATLY REPLACED THE TOBACCO
INDUSTRY AS THE MOST POWERFUL
LOBBY IN WASHINGTON.
THEY PRETTY MUCH GET THEIR WAY.
TO A POINT WHERE THE CONSUMER
DOESN'T HAVE MUCH OF A CHANCE.
SO THE POWER IS VIRTUALLY
COMPLETELY ONE-SIDED ON THE SIDE
OF THE MARKET. ANTI-REGULATORY.
LET THE DOCTOR DO WHAT THE
DOCTOR WANTS TO DO BECAUSE
THE DOCTOR KNOWS BEST. WHEN,
IN FACT. THERE'S NO WAY THE
PHYSICIAN CAN KNOW WHAT TO DO
BECAUSE THERE'S SO MUCH
KNOWLEDGE OUT THERE THAT THEY'RE
VERY VULNERABLE TO PRESSURE
BY INDUSTRY LOBBYISTS.
SO IT'S IN THE NATURE OF
THE BEAST.
IT'S IN THE NATURE OF THE GROWTH
IN KNOWLEDGE. THE GROWTH IN
INFORMATION SYSTEMS. WHICH CAN
BE DISTORTED BY PEOPLE WHO STAND
TO EARN A LOT OF MONEY.
MOUNT SINAI HAD A PRESCRIBER
EDUCATION GRANT THROUGH THE
ATTORNEY GENERAL OF THE STATE OF
OREGON. AND THESE GRANTS WERE
FUNDED TO TEACH PHYSICIANS ABOU THE PHARMACEUTICAL INDUSTRY.
AND THE MONEY CAME FROM A
CLASS-ACTION LAWSUIT ON BEHALF
OF MEDICAID ORGANIZATIONS FROM
A BUNCH OF DIFFERENT STATES
RELATED TO THE IMPROPER
MARKETING OF NEURONTIN
OR GABAPENTIN. WHICH IS A DRUG
FOR--USED FOR SEIZURES AND PAIN.
THE DRUG NEURONTIN WAS
ILLEGALLY MARKETED FOR
UNAPPROVED USES. INCLUDING
TREATMENT FOR BIPOLAR DISORDER.
NEURONTIN HAS NO PROVEN BENEFITS
FOR THIS CONDITION. WHICH LEF THOSE TAKING THIS DRUG
ESSENTIALLY UNTREATED.
AND IT WAS FOUND THAT THE
COMPANY BASICALLY
INAPPROPRIATELY MARKETED.
AND THEY SETTLED WITH A LOT OF
MONEY. AND PART OF THAT MONEY
WAS USED TO FUND EDUCATIONAL
PROJECTS.
SO THAT'S HOW I FIRST BECAME
INTERESTED IN THIS ISSUE.
AS AN OFFSHOOT OF THAT GRANT.
WE--MY COLLEAGUES AND I DID
A RESEARCH PROJECT LOOKING A THE ADHERENCE OF PRIN ADVERTISEMENTS TO FDA
GUIDELINES.
THE BREADTH AND DEPTH TO
WHICH COMPANIES ARE INVOLVED IN
TRAINING AND EDUCATION. AND SOME
OF IT IS QUITE INDIRECT.
AND SOME IS QUITE DIRECT.
YEAH. BECAUSE IT SUPPORTS
A LOT OF ACADEMIA. AND THERE
HAVE BEEN MANY. MANY, MANY
WRITINGS ON THE FACT THA PHYSICIANS HAVE BEEN PAID TO GO
TO MEETINGS. HAVE BEEN PAID TO
SAY CERTAIN THINGS AT MEETINGS.
TO NOT SAY CERTAIN THINGS A MEETINGS.
I MYSELF HAVE BEEN DISINVITED
FROM MEETINGS.
THERE WAS A STUDY NOT TOO
LONG AGO OF HOW COMPANIES USE
THE HIGH GROSS PROFITS FROM
THEIR HIGH PRICES. AND I INCLUDED DOCUMENTING 371.000
PROFESSIONAL MEETINGS A YEAR FOR
DOCTORS.
NOW THERE ARE ONLY 1/2 MILLION
DOCTORS WHO ARE ACTIVE IN THE
UNITED STATES.
SO THAT IS AN AWFUL LOT OF
MEETINGS.
THE BRANCH OF THE FDA THA REGULATES MARKETING MATERIALS
HAD A BUDGET IN 2008 OF
$9 MILLION. APPROXIMATELY, AND
THAT COMPARES WITH THE MARKETING
BUDGET OF THE PHARMACEUTICAL
INDUSTRY IN THE UNITED STATES
IS. DEPENDING ON HOW YOU
CALCULATE IT. ON THE ORDER OF
$30 BILLION TO $60 BILLION
PER YEAR.
AND THE STAKES ARE SO HIGH
AND THE GROSS PROFITS ARE SO
GREAT BECAUSE AMERICAN PRICES
ARE. BY FAR THE HIGHEST IN THE
INDUSTRIALIZED WORLD.
SO THIS IS BIG. BIG BUSINESS,
AND THEY JUST PUT OUT A LOT OF
ADVERTISING. AND INCREASINGLY SO
ON THE WEB. AND THEY HAVE, YOU
KNOW. WEB BANNERS AND SPONSORED
LINKS.
SO THE PUBLIC DOESN'T KNOW
THAT THEY'RE ACTUALLY
SUBSIDIZING 39% OF ALL THE R&D
THAT COMPANIES DO THROUGH
TAX DEDUCTIONS AND TAX CREDITS
AND TAX SUBSIDIES.
IT'S OUR OWN TAXES AND OUR
OWN RETIREMENT SAVINGS WHICH ARE
FINANCING A SYSTEM WHICH IS
LITERALLY LETHAL TO OUR HEALTH.
NOT TO MENTION ANOTHER MAJOR
SOURCE. WHICH NO ONE'S TRIED
CALCULATING. WHICH IS THE
BILLIONS OF DOLLARS THA COMPANIES ACCUMULATE OVERSEAS IN
TAX HAVENS TO AVOID PAYING
U.S. TAX.
THESE ARE COMPANIES THA CONSIDER THEMSELVES VERY
PATRIOTIC.
THEY EVADE AMERICAN TAXES BY
HARBORING BILLIONS OF PROFITS
ABROAD. AND THEN EVERY FIVE OR
SIX YEARS. THE BUSINESS HAS
GOTTEN SO LARGE IN THESE TAX
HAVENS THAT THE CONGRESS GIVES
THEM A TAX HOLIDAY.
I ONCE HELPED A REPORTER
WRITE A WONDERFUL STORY ABOU NOVARTIS. WHO IS THE MAKER OF
RITALIN. AND LITERALLY HOW MUCH
MONEY THEIR STOCK WOULD GO UP
FOR EVERY CHILD THEY GOT ON
RITALIN.
I AM RICH
BEYOND BELIEF
FOR THIS LOVE
YOU HAVE GIVEN ME
THERE WAS AN IDEA THAT THE
NEW NEUROTRANSMITTER HAD BEEN
FOUND CALLED SEROTONIN.
SO ELI LILLY IMMEDIATELY WENT TO
STUDY RATS TO FIND A PILL THA WOULD DO SOMETHING. CHANGE,
THAT IS. CAUSE A DEFECT IN THE
NEUROTRANSMITTER SYSTEM
SO THAT IT COULD BE CLAIMED TO
FIX IT.
AND THEY CAME UP WITH PROZAC.
WHICH BLOCKS THE EFFECTIVE
FUNCTIONING OF THE SYSTEM BY
STOPPING THE REMOVAL OF
SEROTONIN FROM ITS ACTIVE PLACE
IN THE BRAIN AND FLOODING THE
BRAIN WITH IT.
THEY FOUND QUICKLY THAT PROZAC
CAUSED SO MUCH AGITATION IN
PATIENTS THAT THEY HAD TO GIVE
THE PATIENTS TRANQUILIZERS. OR
THEY'D DROP OUT OF THE STUDIES.
WELL. WHEN IT CAME DOWN TO
APPROVING THE DRUG. THEY
COULDN'T FIND A BENEFICIAL
EFFECT UNLESS THEY INCLUDED THE
TRANQUILIZED PATIENTS.
SO THE FDA FORGAVE ELI LILLY
FOR CHEATING AND APPROVED
ELI LILLY'S DRUG PROZAC WHEN
THEY REALLY WERE APPROVING--
THEY DIDN'T TELL ANYBODY THIS--
REALLY APPROVING PROZAC WITH ITS
AGITATION COVERED OVER BY
ADDICTIVE TRANQUILIZING DRUGS.
SO. AS THE MEDICAL EXPERT,
WE FINALLY HAD OUR FIRST TRIAL.
NOW. I WONDERED WHY--WHY WOULD
THIS BE THE FIRST TRIAL THAT WE
WOULD BRING OUT OF THE 150.
BECAUSE IT WAS A VERY DIFFICUL CASE.
THIS MAN. JOSEPH WESBECKER, HAD
BEEN PARANOID AND HATEFUL
AND THREATENING TOWARD PEOPLE A WORK BEFORE HE WAS PUT ON
PROZAC.
THAT'S NOT THE BEST CASE.
BUT WHEN HE WAS PUT ON PROZAC.
WITHIN DAYS. HE GOT PSYCHOTIC,
AND HE KILLED A DOZEN PEOPLE AND
INJURED 20 AT HIS PLACE OF WORK.
SO I WAS GONNA TESTIFY THAT I WASN'T THAT PROZAC JUST CAUSED
THIS. BUT PROZAC TIPPED HIM
OVER.
WELL. I GET READY TO HAVE THE
TRIAL. AND MY--THE LAWYER ON OUR
SIDE ISN'T PREPARING ME.
HE'S NOT SENDING ME ANYMORE
MATERIALS.
I ARRIVE IN LOUISVILLE. AND THE
LAWYER FOR OUR SIDE. WHO'S SUING
LILLY. IS HIDING DOCUMENTS
FROM ME.
I WAS THROWN ON THE STAND WITH
NO PREPARATION.
I GAVE THE LAWYER 20 OR 30
NOTE CARDS BEFORE I WENT ON THE
STAND AND SAID. "YOU'VE GOT TO
ASK ME THESE QUESTIONS."
HE GOT MAD AT ME.
WELL. IT WAS VERY HARD TO
TESTIFY UNDER THOSE CONDITIONS.
AS IT WAS. LILLY ALMOST LOS THE CASE.
IT WAS A 9-3 VOTE. WHICH ALLOWED
THEM TO WIN.
ONE MORE VOTE AGAINST THEM. AND
THEY WOULD HAVE LOST.
BIG HEADLINES: "LILLY WINS ITS
CASE."
AND ALL THE OTHER LAWYERS
STARTED TO SETTLE FROM THE 150
OR MORE OTHER CASES.
WELL. THE JUDGE FIGURED OUT THA THIS TRIAL HAD BEEN FIXED.
HE CALLED TOGETHER ELI LILLY AND
MR. SMITH. WHO WAS THE LAWYER
FOR THE PLAINTIFFS. AND SAID
THAT. "WHAT DID YOU GUYS DO?"
AND THEY SAID. "IT'S NONE OF
YOUR BUSINESS."
SO NOW THE JUDGE IS UP AGAINS BOTH PARTIES ON THE TRIAL.
SO THE JUDGE INVESTIGATES.
AND HE FINDS OUT THAT OUR SIDE
WAS INDEED PAID OFF IN ORDER TO
PRESENT A WEAK CASE SO LILLY
COULD WIN.
AND OUR SIDE TRIED TO DISCREDI ME IN COURT. MY OWN SIDE TRIED
TO DISCREDIT ME IN COURT.
BECAUSE LILLY NEEDED TO WIN THE
CASE. AND THEY NEEDED TO
DISCREDIT PETER BREGGIN.
BECAUSE I WAS THEIR ONLY REAL
OPPOSITION IN THE WORLD.
I NEED A BAILOU JUST LIKE CITIGROUP
I NEED A BAILOU DON'T FORGET AIG
GOLDMAN SACHS
I NEED A BAILOU WHAT ABOUT THE BIG THREE?
I NEED A BAILOU IT ALL ENDS WITH JUST ME
I NEED A BAILOU JUST LIKE CITIGROUP
I NEED A BAILOU DON'T FORGET AIG
GOLDMAN SACHS
I NEED A BAILOU BAILOUT. BAILOUT, BAILOU BAILOUT. BAILOU SOME DOCTORS. INCLUDING
MYSELF. GET FRUSTRATED WITH THE
FDA SOMETIMES. BECAUSE THERE ARE
MEDICATIONS THAT WORK WELL IN
EUROPE AND OTHER COUNTRIES THA HAVE BEEN OUT FOR YEARS. BUT I TAKES ANOTHER 10. 12 YEARS TO
GET APPROVED IN THIS COUNTRY.
SO IN MANY WAYS. THEY'RE VERY
CAREFUL. AND THE PROCESS IS VERY
SLOW.
BUT IN OTHER SITUATIONS.
CERTAIN DRUGS ARE FAST TRACKED.
SO WHEN YOU--WHEN YOU LOOK A SITUATIONS LIKE FEN-PHEN.
A DRUG THAT WAS REALLY POPULAR
IN THE '90s FOR WEIGHT LOSS.
PEOPLE--A LOT OF PEOPLE DIED
FROM THAT DRUG.
A LOT OF PEOPLE ARE STILL ALIVE
NOW THAT ARE HAVING LONG-TERM
HEART PROBLEMS FROM THAT--
FROM THAT DRUG COMBINATION.
THEY KNEW BEFORE THAT DRUG WAS
RELEASED THAT THERE WAS
A PROBLEM.
PEOPLE IN THAT PARTICULAR
COMPANY KNEW.
INFORMATION WAS SUPPRESSED.
BECAUSE WHEN YOU GO THROUGH R&D.
RESEARCH AND DEVELOPMENT.
TO GET A DRUG BROUGHT TO MARKET.
IT COULD TAKE SEVERAL YEARS.
TENS OF MILLIONS OF DOLLARS ARE
SPENT DOING THIS PROCESS.
SO WHEN THAT DRUG GETS READY TO
BE RELEASED BY THE FDA.
IT IS A BIG DEAL IF IT DOES NO GET RELEASED. BECAUSE THEY'VE
ALREADY SPENT A LOT OF MONEY.
AND REMEMBER. PHARMACEUTICAL
COMPANIES ARE FOR PROFIT.
THEY'RE NOT NON-PROFIT. GOOD,
YOU KNOW. TOUCHY-FEELY
CORPORATIONS.
THEY ARE TRYING TO MAKE MONEY.
I REMEMBER I TOLD MY SON.
"DO YOU REALIZE WHAT YOU'RE
DOING TO YOURSELF?"
"MOM. YOU KNOW, I--THESE--
THEY GOT 'EM FROM A DOCTOR.
A DOCTOR'S NOT GONNA GIVE YOU
ANYTHING BAD."
SO I DON'T KNOW IF THEY HAVE I IN THEIR HEAD OF. "OKAY, WELL,
I'M NOT BUYING IT ON THE STREET.
I'M NOT BUYING IT FROM THE DRUG
DEALER ON THE CORNER.
I'M NOT BUYING IT FROM--
YOU KNOW. IN AN ALLEY SOMEWHERE.
I'M GOING INTO A DOCTOR'S
OFFICE. AND I'M BUYING
MEDICATION.
AND IT'S FINE.
WHY WOULD HE GIVE ME SOMETHING
THAT'S GONNA HURT ME?"
THE FOOD AND DRUG
ADMINISTRATION BECAME
RESPONSIBLE FOR CERTIFYING DRUGS
AS BEING SAFE AND THEN.
EVENTUALLY. FOR BEING SAFE
AND EFFECTIVE. WHICH MEANS
THAT NO DRUG--NO PRESCRIPTION
DRUG. NO ANY KIND OF MEDICAL
DRUG CAN BE LICENSED FOR PUBLIC
USE IN THE UNITED STATES WITHOU THE PRIOR APPROVAL OF THE FDA.
NOW. THAT'S A VERY STRONG PIECE
TO HAVE ON THE BOARD. A VERY
STRONG POSITION TO HAVE.
THE FDA HAS BUILT UP IN
STRENGTH AND DEPTH EACH TIME
AROUND A DRUG DISASTER WHERE
A MANUFACTURER HAS PUT A REALLY
DANGEROUS DRUG OUT THERE AND NO WITHDRAWN IT QUICKLY. AND THAT'S
LED TO CONGRESSIONAL
INVESTIGATIONS AND THEN
A RAMPING UP OF THE REGULATORY
BODY.
I THINK AT SOME TIMES IN
ITS HISTORY. THE FDA HAS BEEN
VERY IMPORTANT IN THE REGULATION
AND MONITORING OF MEDICATIONS IN
THE COUNTRY.
UNFORTUNATELY. IT, TOO, HAS BEEN
CO-OPTED BY THE INDUSTRY.
HAS BEEN HAPPENING GRADUALLY
OVER THE LAST 20 YEAR--REALLY.
OVER 30 YEARS.
A LOT OF TIMES. YOU HAVE
DRUGS THAT MAYBE SHOULDN'T EVEN
BE ON THE MARKET AT ALL GET PU ON THE MARKET. AND PEOPLE STAR DYING. AND PEOPLE START HAVING
SIDE EFFECTS. BUT NOTHING REALLY
HAPPENS UNTIL AT LEAST THEY'VE
RECOUPED MONEY. MADE A PROFIT.
THEN THE FDA COMES RIDING IN ON
A WHITE HORSE AND PULLS THE VERY
SAME DRUG THAT SHOULD NEVER HAVE
BEEN ON THE MARKET IN THE FIRS PLACE OFF THE MARKET.
THE PROBLEM IS THAT WHENEVER
A GOVERNMENT AGENCY MONITORS
AN OUTSIDE ACTIVITY. IT IS
EVENTUALLY BOUGHT AND CONTROLLED
BY THAT WHICH IT MONITORS.
SO I THINK THERE ARE A LOT OF
VERY HARDWORKING. CONSCIENTIOUS,
HIGHLY TRAINED PEOPLE AT THE
FDA. ESPECIALLY THE REVIEWERS,
WHO ARE GREAT PUBLIC SERVANTS.
ONE PATTERN THAT WE HAVE FOUND
IN RECENT TIMES BUT GOES BACK
TO THE '70s. I'VE FOUND,
IS SENIOR MANAGEMENT OVERRIDING
WORRIES AND WARNINGS BY THEIR
OWN REVIEWERS. BASICALLY
APPROVING A DRUG THAT THEIR OWN
REVIEWERS SAY SHOULD NOT BE
APPROVED BECAUSE IT'S TOO
DANGEROUS TO GO ONTO THE MARKET.
IT'S SOMEWHAT DIFFICULT FOR
THE FDA TO GET PHYSICIANS
BECAUSE THEY DO NOT PAY ANYWHERE
NEAR AS MUCH AS MOST PHYSICIANS
WOULD MAKE IN AN ACADEMIC
MEDICAL CENTER OR CERTAINLY AS
THEY WOULD MAKE IN THE DRUG
INDUSTRY.
THEY GET DOCTORS AND THERE ARE
A LOT OF VERY DEDICATED
PHYSICIANS AT THE FDA.
BUT FREQUENTLY. THE MOS DEDICATED ONES ARE DRIVEN OU BECAUSE THEIR DECISIONS ABOU THE DANGERS OF DRUGS ARE
OVERTURNED.
WE DID A STUDY OF PHYSICIANS A THE FDA IN 1998.
BETWEEN THEM. THEY CITED 27
INSTANCES IN WHICH A DRUG THA THEY THOUGHT WAS TOO DANGEROUS
TO BE APPROVED WAS APPROVED OVER
THEIR HEAD. GOT ON THE MARKET,
AND IN MANY CASES. THE DRUGS
HAVE NOW BEEN TAKEN OFF
THE MARKET.
SO IF YOU ARE GOING INTO THE
GOVERNMENT WANTING TO ENGAGE IN
PUBLIC HEALTH SERVICE. BEING
WILLING TO TAKE A LOWER SALARY.
AND YET YOU'RE BEING THWARTED
FROM YOUR PUBLIC HEALTH MISSION
BECAUSE YOUR BOSSES ARE
OVERTURNING YOU PARTLY BECAUSE
THEY DON'T WANT TO DISPLEASE
THE DRUG INDUSTRY. IT'S NO A VERY WELCOME ATMOSPHERE.
AND SO TREMENDOUS
PHARMACEUTICAL COMPANY INFLUENCE
HAS BEEN EXERTED ON THE FDA TO
APPROVE DRUGS MANUFACTURED BY
THESE COMPANIES AS SAFE AND
EFFECTIVE. NATURALLY.
THE RHETORIC OF THE INDUSTRY
IS. WE NEED TO DO EVERYTHING WE
CAN TO GET LIFE-SAVING DRUGS TO
PATIENTS WHO NEED THEM AS
QUICKLY AS POSSIBLE.
AND THAT RHETORIC PREVAILS.
THAT'S WHAT CONGRESSMEN BELIEVE
AND JOURNALISTS BELIEVE
AND SO FORTH.
THE REALITY IS THE FOLLOWING:
THAT--THAT SEVERAL INDEPENDEN OF SIX NEW DRUGS. ABOUT 85% OF
NEW DRUGS. ARE LITTLE OR NO
BETTER THAN EXISTING DRUGS
AGAINST CLINICAL MEASURES.
THEY CAN'T BE LIFE-SAVING.
BECAUSE THEY'RE NO---THEY'RE
LITTLE OR NO BETTER.
AND A FEW YEARS AGO.
THE INDUSTRY WAS SUCCESSFUL IN
GETTING THE TIME TO REVIEW OF
MEDICATIONS REDUCED SO THA THE FDA COULD GO THROUGH ITS
REVIEW PROCESS MORE QUICKLY.
AND THAT'S BEEN ASSOCIATED WITH
A MUCH HIGHER RATE OF APPROVAL
OF DRUGS. A MUCH HIGHER RATE OF
APPROVAL OF DANGEROUS DRUGS.
THE VIOXX DISASTER LED THE
FDA AND CONGRESS AND LEADING
POLICY RESEARCHERS TO BECOME
VERY SERIOUSLY CONCERNED ABOU HOW UNSAFE DRUGS WERE.
VIOXX IS A DRUG MADE BY MERCK
THAT WAS TOUTED AS BEING GENTLER
ON THE STOMACH.
IT'S A PAINKILLER.
AND IN THEIR EFFORT TO PROVE
THAT IT WAS GENTLE ON THE
STOMACH. THE COMPANY. MERCK,
DID A STUDY.
HALF THE PEOPLE GOT VIOXX AND
HALF OF THEM GOT ANOTHER
PAINKILLER. NAPROXEN. WHICH HAS
BEEN ON THE MARKET FOR A LONG
TIME.
THE PEOPLE THAT GOT VIOXX HAD
FOUR TIMES MORE HEART ATTACKS
THAN THE PEOPLE THAT GO NAPROXEN.
WHEN THAT STUDY WAS PUBLISHED.
WE LOOKED AT THE STUDY.
IT WAS PUBLISHED IN NOVEMBER
OF 2000.
IT WAS NO MORE EFFECTIVE AS A
PAINKILLER THAN A LOT OF OTHER
DRUGS THAT DIDN'T CAUSE
HEART ATTACKS.
IT TOOK THE FDA SEVERAL YEARS
AND YET ANOTHER STUDY SHOWING
THAT IT CAUSED HEART ATTACKS TO
GET THE DRUG TAKEN OFF THE
MARKET.
MERCK PUSHED THE FDA ALL OVER
THE PLACE TO THE POINT WHERE
THEY DIDN'T EVEN PUT AN ADEQUATE
WARNING. LET ALONE TAKE IT OFF
THE MARKET.
AND IT STARTS WITH SOMETHING
THE FDA IS NOT ATTENDING TO:
HAVING COMPANIES TEST THEIR OWN
PRODUCTS. AND THEY NATURALLY
WANT TO DESIGN THOSE TESTS TO
MINIMIZE EVIDENCE OF HARMFUL
SIDE EFFECTS AND MAXIMIZE
EVIDENCE OF BENEFITS SO THEIR
DRUGS WILL BE APPROVED.
IT'S QUITE CLEAR THA CLINICAL TRIALS THAT ARE
SPONSORED BY INDUSTRY ARE FAR
MORE LIKELY TO BE POSITIVE.
TO SORT OF FIND THAT THE DRUG
WORKS AS COMPARED WITH PUBLICLY
FUNDED STUDIES THAT ARE FUNDED
BY THE NATIONAL INSTITUTES OF
HEALTH OR NON-PROFI FOUNDATIONS.
THOSE TRIALS NOT ONLY ARE
MISLEADING IN THEIR RESULTS
AND THEREFORE MISLEAD THE REVIEW
PROCESS. BUT THEY DON'T PROVIDE
USEFUL INFORMATION TO CLINICIANS
ON HOW TO USE THE DRUG.
WHEN THESE SO-CALLED DRUGS
ARE APPROVED ON THE BASIS OF
THEIR RANDOMIZED CONTROL TRIAL.
THEY'RE USED IN PRACTICE WITHOU ANY ACCOUNTABILITY.
THERE IS NO INFORMATION SYSTEM
THAT SYSTEMATICALLY LOOKS FOR
THE IMPACT OF THESE APPROVED
MEDICATIONS ON PEOPLE'S HEALTH.
SO WE'RE NOT LOOKING.
WE'RE NOT HOLDING OURSELVES
ACCOUNTABLE FOR WHAT WE'RE
PRESCRIBING IN THE FIELD OF
MEDICAL CARE.
YOU HAVE LOBBYISTS.
YOU HAVE PEOPLE WHO WORK FOR THE
FDA WHO EVENTUALLY GO TO WORK
FOR THE PHARMACEUTICAL
COMPANIES. AND SOME OF THEM
COME BACK AND WORK FOR THE FDA.
THEN MOVE ON TO BEING
A VICE PRESIDENT OF. PERHAPS.
REGULATORY AFFAIRS AT A DRUG
COMPANY.
PERFECT POSITION FOR A REGULATOR
TO GO TO FROM THE COMPANY'S
POINT OF VIEW.
KNOWS ALL THE INSIDE BYWAYS AND
HIGHWAYS.
INCREASINGLY. PARTICULARLY
SINCE 1992. MOST OF THE FUNDING
FOR REVIEWING DRUGS COMES
DIRECTLY IN CASH PAYMENTS FROM
THE DRUG INDUSTRY TO THE FDA.
IT'S A MASSIVE AND ALMOS LUDICROUS CONFLICT OF INTEREST.
BUT IT'S ONE THAT WAS PASSED BY
CONGRESS AS A WAY OF BALANCING
THE BUDGET.
THEY PAY UPWARDS OF $800.000.
$900.000 PER DRUG.
THEY HAVE TO PAY THE MONEY
WHETHER THE FDA APPROVES THE
DRUG OR NOT. BUT IT CREATES
A WHOLE ATTITUDE. A DIFFEREN ATTITUDE THAN USED TO EXIS BEFORE 1992.
AS TO HOW MUCH POLICING THE FDA
HAS DONE.
THAT INEVITABLY IS GOING TO
MEAN THAT THE FDA PROCESS IS
GOING TO CHANGE BECAUSE OF THE
MONEY THAT THEY GET.
THE SIZE OF THE PEOPLE WHO ARE
WORKING IN THE FDA ON MOVING THE
APPROVAL OF DRUGS FORWARD.
THERE ARE MORE PEOPLE DOING
THAT. AND YOU HAVE LESS PEOPLE
WHO ARE INVOLVED MONITORING
MARKETING PRACTICES OF DRUG
COMPANIES. WHO ARE MONITORING
DRUG SAFETY.
BASICALLY. COMPANIES. THROUGH
THEIR LOBBYING. GOT CONGRESS TO
AGREE THAT THEY WOULD PAY FOR
THE FDA.
THEY GET QUICKER APPROVALS.
THAT MEANS THEY MAKE BILLIONS
MORE IN REVENUES AND PROFITS.
AND IN RETURN. MORE PEOPLE GE SERIOUSLY ILL. HOSPITALIZED.
AND DIE.
BECAUSE WE'VE INCREASED THE
NUMBER OF DRUGS. WE'VE INCREASED
THE ADVERSE EVENT RATES FROM
DRUGS FOUR TIMES THAN WE'VE
INCREASED THE PRESCRIPTION RATE.
SO THAT THE ADVERSE EVENT RATE--
EVENT RATES FOR MEDICATIONS ARE
GETTING BIGGER AND NOT SMALLER.
AND FOR SOME MEDICATIONS.
WE'VE INCREASED THE ADVERSE
EVENT RATES 16 TIMES WHAT IT WAS
TEN YEARS AGO.
SO THERE'S NO QUESTION IN MY
MIND THAT THE EVIDENCE SHOWS--
STRONG EVIDENCE--THAT ADVERSE
EVENTS FROM MEDICATIONS ARE THE
FOURTH LEADING CAUSE OF DEATH.
I WROTE AN ARTICLE IN THE
JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION TEN YEARS AGO.
INTERESTINGLY ENOUGH. THE
ARTICLE WAS ORIGINALLY SUBMITTED
TO ANOTHER JOURNAL--A VERY
HIGH-LEVEL. PREMIER JOURNAL.
WHICH REJECTED IT ON THE GROUNDS
THAT NOBODY WOULD BE INTERESTED
IN IT.
IT WAS AN ARTICLE THA DOCUMENTED THE FACT THAT THE
UNITED STATES RANKED VERY POORLY
ON HEALTH LEVELS WITH REGARD TO
OTHER COMPARABLE COUNTRIES--
INDUSTRIALIZED COUNTRIES IN THE
WORLD.
AND IT ALSO DOCUMENTED THE FAC THAT WE HAD A VERY HIGH RATE OF
ADVERSE EVENTS FROM THE USE OF
VARIOUS INTERVENTIONS IN THE
HEALTH CARE FIELD.
AND SINCE THAT ARTICLE WAS
PUBLISHED 11 YEARS AGO. I HAVE
CONTINUED TO GET REQUESTS FOR
REPRINTS.
I STILL GET ABOUT FIVE REQUESTS
FOR REPRINTS EVERY WEEK.
THE ARTICLE HAS GOTTEN A LOT OF
ATTENTION. MOSTLY. I THINK,
FROM LAYPEOPLE. ALMOST NO
ATTENTION FROM GOVERNMENT.
I HAVE NEVER BEEN CONTACTED BY
THE FDA TO EXPLAIN WHAT I'VE
DONE OR TO EXPLORE THE
RAMIFICATIONS.
AND I THINK THAT'S BECAUSE
PEOPLE DON'T LIKE TO KNOW THA MEDICATIONS CAN BE HARMFUL AND
THAT THEY. IN FACT. MAY ACCOUN AT LEAST IN PART FOR THE FAC THAT WE DON'T DO VERY WELL
INTERNATIONALLY IN OUR HEALTH
LEVELS.
SO HOW IS THE CARTEL GOING TO
PRESENT ITSELF AS. REALLY.
THE ONE AND ONLY SOLUTION TO
THE PROBLEM OF ILLNESS?
THROUGH MEDIA.
COULD YOU IMAGINE A SOCIETY
WHERE PEOPLE ADVERTISED.
YOU KNOW. HEROIN ON TELEVISION?
YOU KNOW. "I GOT BLUE MAGIC.
DA DA DA DA DA.
CALL THIS NUMBER OR. YOU KNOW.
THIS WEBSITE."
YOU KNOW. LIKE. THAT'S FUNNY,
BECAUSE YOU COULDN'T IMAGINE
THAT.
BUT YOU NOW HAVE PHARMACEUTICAL
COMPANIES SELLING DRUGS THROUGH
COMMERCIALS ON TELEVISION.
BILLBOARDS. AND SUCH.
THE UNITED STATES IS ONE OF
VERY FEW COUNTRIES IN THE WORLD
IN WHICH DIRECT-TO-CONSUMER
ADVERTISING IS LEGAL. AND IT'S
CONSIDERED A FREE SPEECH RIGH IN THE U.S.. AND IT'S PROTECTED
AS A FREE SPEECH RIGHT HERE.
PROPONENTS OF DIRECT-TO-CONSUMER
ADVERTISING SAY THAT IT HELPS
FACILITATE COMMUNICATION BETWEEN
DOCTORS AND PATIENTS. THAT I INFORMS PATIENTS OF THINGS AND
SORT OF HELPS THEM TO BE ABLE
TO TALK ABOUT THEM WITH THEIR
DOCTORS.
AND THERE ACTUALLY IS SOME
EVIDENCE THAT THAT'S TRUE.
THERE'S ALSO EVIDENCE THAT IT--
IT INCREASES PRESCRIBING OF
ADVERTISED DRUGS. AND.
OBVIOUSLY. YOU KNOW. THE
PHARMACEUTICAL INDUSTRY ARE
PRETTY SMART.
AND THEY WOULDN'T DO IT IF I DIDN'T WORK.
THERE'S NO COUNTERBALANCE TO
THAT.
SO IN OTHER WORDS. WHEN A PERSON
IS WATCHING TELEVISION AND THEY
SEE THIS AD COMES ON. AND THEY
SAY. "ARE YOU NOT GETTING ENOUGH
SLEEP AT NIGHT?
ARE YOU RESTLESS?
ARE YOU ANXIOUS?
YOU HAVING PROBLEMS IN THE
BEDROOM?
ALMOST ANYBODY WATCHING THESE
COMMERCIALS CAN RELATE TO SOME
OF THESE PROBLEMS AT SOME POIN IN TIME. AND THEN ALL THE WHILE.
IT'S JUST BEAUTIFUL COMMERCIALS
ROLLING. PEOPLE IN SLOW MOTION.
FROLICKING THROUGH THE FOREST.
HOLDING HANDS. BEAUTIFUL MUSIC.
YOU HAVE A GUY READING IN A VERY
LOW VOICE OF ALL THE POTENTIAL
SIDE EFFECTS.
BUT OUR VISUAL--THERE'S A VISUAL
DISCONNECT.
WE HAVE THE SIDE EFFECTS BEING
READ REALLY LOW VOLUME AND
FAST. AND YOU HAVE THE PEOPLE
THAT LOOK LIKE THEY'RE JUS ENJOYING THEIR LIFE.
AND YOU HAVE PEOPLE THAT END UP
GOING TO THEIR DOCTOR'S BASED ON
A COMMERCIAL. ASKING FOR A PILL.
HIGH FEVER. STIFF MUSCLES.
AND CONFUSION TO ADDRESS A
POSSIBLE LIFE-THREATENING
CONDITION. OR IF YOU HAVE
UNCONTROLLABLE MUSCLE MOVEMENTS.
AS THESE COULD BECOME PERMANENT.
HIGH BLOOD SUGAR HAS BEEN
REPORTED WITH ABILIFY AND
MEDICINES LIKE IT.
IN SOME CASES. EXTREME HIGH
BLOOD SUGAR CAN LEAD TO COMA OR
DEATH.
OTHER RISKS INCLUDE DECREASES...
THE--THE FDA GUIDELINES ARE
KIND OF LEGALISTIC. BUT THEY'RE
ALSO VERY. VERY VAGUE.
SO THEY DON'T PARTICULARLY
MANDATE THE PRESENCE OF
IMPORTANT INFORMATION.
THEY JUST MANDATE THE ABSENCE OF
OVERTLY MISLEADING INFORMATION.
BECAUSE THE FDA IS SO UNABLE TO
LOOK AT ALL OF THE MARKETING
MATERIALS THAT ARE OUT THERE. WE
FELT IT WAS IMPORTANT TO LOOK A THE ADHERENCE OF MATERIALS TO
THEIR GUIDELINES.
SO WHAT WE FOUND IN THE CASE OF
CONSUMER-DIRECTED ADS IS THA RELATIVELY FEW OF THE ADS WERE
CLEARLY ADHERENT.
BUT MOST OF THE TIME. THAT WAS
BECAUSE OF INCOMPLETE
INFORMATION.
THEY'RE JUST WAS NOT THE
INFORMATION PRESENT IN THE AD
FOR US TO EVEN ASSESS THE
ADHERENCE TO THE FDA GUIDELINES.
WE ALSO FOUND THAT OVER 1/4 OF
THE DRUGS THAT WERE ADVERTISED
IN OUR SAMPLE HAD A BLACK BOX
WARNING FROM THE FDA.
SO A BLACK BOX WARNING IS AN
INDICATION FROM THE FDA THAT A
DRUG IS PARTICULARLY DANGEROUS.
IF YOU ARE PRESCRIBED A DRUG.
AND YOU GET THE PACKAGE'S
INSERT. YOU'LL ACTUALLY SEE A
WARNING IN BOLD LETTERS IN A
BLACK RECTANGLE.
WELL. HOW DO I FEEL ABOUT THE
WAY THIS COUNTRY HAS GONE OVER
THE--MY PROFESSIONAL LIFETIME.
THE FACT THAT IT'S FALLING
FURTHER AND FURTHER BEHIND IN
POPULATION HEALTH.
IT'S FALLING FURTHER AND FURTHER
BEHIND IN PEOPLE'S SATISFACTION
WITH THE HEALTH CARE SYSTEM.
IT'S GOING FURTHER AND FURTHER
BEHIND IN TERMS OF COST CONTROL
AND. IN GENERAL. JUST SIMPLY NO KEEPING UP WITH THE NECESSARY
CHANGES.
IT'S VERY DISAPPOINTING. AND I MAKES ME VERY UNHAPPY. BOTH FROM
A PROFESSIONAL POINT OF VIEW AS
WELL AS FROM A PERSONAL POINT OF
VIEW.
I KNOW THAT PROBABLY EVER SINCE
I STARTED WRITING ABOUT PRIMARY
CARE. WHICH WAS IN THE EARLY
1990s. I HAVE BEEN DELIBERATELY
SHUT OUT OF POLICY MAKING GROUPS
AND CONSULTANCIES.
AND BASICALLY THE ONLY THING
THAT KEEPS ME GOING IS THE FAC THAT I AM WELL REGARDED
SCIENTIFICALLY AND
PROFESSIONALLY.
I THINK NO ONE HAS EVER MOUNTED
A CHALLENGE TO MY USE OF
EVIDENCE. AT LEAST I AM NO AWARE OF IT.
THEY CERTAINLY HAVEN'T DONE I IN PROFESSIONAL MEDIA.
SO I REALLY DON'T HAVE MUCH
DISSATISFACTION ABOUT THE
CONTRIBUTIONS I'VE MADE TO
SCHOLARSHIP AND TO KNOWLEDGE
ABOUT THE WAY HEALTH CARE SHOULD
BE PROVIDED. BUT IT HAS BEEN
PERSONALLY DISAPPOINTING THAT MY
WORK HAS NOT LED TO POSITIVE
CHANGE OVER MY LIFETIME.
THE OBAMA ADMINISTRATION'S
HEALTH CARE POLICY STILL LEF THE INSURANCE COMPANIES IN
CHARGE.
IT WAS REFORMED WITHIN THE
CONTEXT OF A FOR-PROFIT SYSTEM.
INSURANCE COMPANIES ARE STILL
RAISING THEIR RATES TO THE ROOF.
IT ALSO DIDN'T DO ANYTHING TO
TOUCH THE PHARMACEUTICAL
INDUSTRY. BECAUSE. ESSENTIALLY,
WITH MEDICARE PART D STILL
INTACT. THE PHARMACEUTICAL
COMPANIES CAN CONTINUE TO NAME
THEIR PRICE FOR PRESCRIPTION
DRUGS AND GET IT.
SO THE GOVERNMENT. THEN. HAS
A DUAL BURDEN. WHICH IS MORE
PRESSURE ON THE MEDICARE BUDGE THROUGH THE PHARMACEUTICAL
COMPANIES TAKING A BIG CHUNK OU OF IT AND GREATER PRESSURE ON
THE ENTIRE HEALTH CARE SYSTEM
THROUGH ABOUT ONE OUT OF EVERY
THREE DOLLARS GOING FOR THE
ACTIVITIES OF THE FOR-PROFI SYSTEM--CORPORATE PROFITS. STOCK
OPTIONS. EXECUTIVE SALARIES.
ADVERTISING. MARKETING. THE COS OF PAPERWORK.
I SPOKE ABOUT THE URGENT NEED
FOR HEALTH CARE REFORM AND WHA WILL BE REQUIRED TO ACHIEVE IT.
AND ONE OF THE THINGS THAT WILL
BE REQUIRED. I SAID. WAS THA EVERYONE IN OUR HEALTH CARE
COMMUNITY IS GONNA HAVE TO COME
TOGETHER AND DO THEIR PART.
IN RECENT DAYS.
CHAIRMAN MAX BAUCUS. WHO'S BEEN
DOING AN OUTSTANDING JOB LEADING
THE FINANCE COMMITTEE ON THIS
ISSUE...
WHAT I'M HOLDING IS A BOTTLE
OF ZYPREXA.
ZYPREXA IS AN ANTI-PSYCHOTIC
MEDICATION.
IT'S VERY POPULAR. AND IT'S VERY
EXPENSIVE.
THIS AMONG SOME OF THE OTHERS.
ABILIFY. CIALIS--ERECTILE
DYSFUNCTION DRUGS--ARE VERY
COMMONLY DIVERTED.
THE REASON BEING IS. AGAIN. THE
MEDICAL PROGRAMS AND INSURANCE
PROGRAMS PAY A LOT OF MONEY FOR
THESE DRUGS.
I'M A SALES REP FOR
A PHARMACEUTICAL COMPANY.
BEEN DOING IT FOR ABOUT A YEAR.
AND MY JOB IS ESSENTIALLY TO
SELL OUR PRODUCTS TO PHYSICIANS.
YOU CAN BE FIRED FOR TALKING TO
PHYSICIANS OFF-LABELING.
NOW. DOES IT HAPPEN?
IT HAPPENS OFTEN. AND IT HAPPENS
FREQUENTLY.
OFF-LABEL PROMOTION IN
ATTEMPTING TO SELL A DRUG FOR
A DISEASE THAT THE FDA HASN' APPROVED IT FOR.
LET'S SAY A DRUG GETS APPROVED
BY THE FDA FOR ONE PURPOSE.
AND IT DOESN'T SELL VERY MUCH.
SO THE COMPANY SAYS. "HMM. MAYBE
WE CAN PRETEND. BY ADVERTISING
AND PROMOTION AND BUYING UP
DOCTORS TO SPREAD THE BUZZ.
THAT THIS DRUG IS ALSO GOOD FOR
THE SECOND AND THIRD AND FOURTH
AND FIFTH DISEASE."
THEIR MARKETING IS INGENIOUS.
IT IS SO ILLEGAL. IT MAKES THE
COLOMBIAN CARTEL LOOK LIKE
CHILD'S PLAY.
ELI LILLY KNOWS HOW LONG IT'S
DRUG IS PATENTED AND HOW LONG
THEY'RE GONNA CHARGE A PREMIUM
PRICE FOR THAT DRUG.
AND AS SOON AS THAT DRUG GOES
GENERIC. THEY NEED ANOTHER DRUG
TO REPLACE IT TO REPLACE THOSE
PROFITS. BECAUSE SHAREHOLDERS
EXPECT PROFITS AND A RETURN ON
THEIR INVESTMENT.
SO PROZAC IS GOING OFF PATENT.
AND THEY NEED TO REPLACE THOSE
PROFITS.
SO THEY TAKE ZYPREXA. AND THEY
DEVELOP THIS ELABORATE SCHEME TO
MARKET ZYPREXA TO THE ELDERLY
AND TO THE CHILDREN. TO ANYBODY
OFF-LABEL.
THIS IS A CRIMINAL ACT ON THE
PART OF A COMPANY.
IF THEY DO THIS. THEY'RE
ESSENTIALLY MAKING IT SEEM AS
THOUGH THIS DRUG IS SAFE ENOUGH.
RELATIVE TO ITS BENEFITS.
TO BE PROMOTED.
THE FACT IS. IF IT HASN'T BEEN
APPROVED AT ALL FOR THA OFF-LABEL OR SECOND PURPOSE.
WE DON'T KNOW WHETHER THE
BENEFITS OUTWEIGH THE RISK
OR WHETHER THE RISKS OUTWEIGH
THE BENEFITS.
IF THERE WAS ENOUGH EVIDENCE OF
THAT. IT WOULD BE ON-LABEL.
THE FDA WOULD GET THE EVIDENCE
AND WOULD APPROVE IT.
SO THE ELDERLY THAT WERE
PLACED ON ZYPREXA DIED TERRIBLY
PAINFUL DEATHS.
ELI LILLY HAD PSYCHIATRISTS IN
THEIR STAFF DEVELOP
A PSYCHOLOGICAL PROFILE OF THE
DOCTORS PRESCRIBING ZYPREXA.
THEY WOULD DIRECT THE MARKER TO
SAY. "NO MATTER HOW DUMB YOUR
DOCTOR IS. DON'T TALK DOWN TO
HIM."
PHARMACEUTICAL
REPRESENTATIVES ARE UNIVERSALLY
ATTRACTIVE.
THEY GET RECRUITED FROM PLACES
LIKE CHEERLEADING SQUADS AT BIG
TEN SCHOOLS. IN THE CASE OF
WOMEN. AND IT'S QUITE CLEAR THA PART OF THEIR HIRING PROCESS IS
THE ATTRACTIVENESS OF
THE PEOPLE.
THEY DON'T PARTICULARLY HAVE
A LOT OF MEDICAL BACKGROUND.
YOU KNOW. THEY ARE MARKETERS.
BUT THEY GO TO SORT OF BOOT CAMP
TO LEARN ABOUT THEIR DRUG.
THEY'RE GOING TO PRIMARY CARE
PHYSICIANS. WHO ARE TREATING
YOU AND I. AND TELLING THEM HOW
TO MANAGE THEIR PATIENTS.
WHO MIGHT JUST HAVE A SLEEP
DISORDER.
AND I GUESS THE MOS FRUSTRATING THING TO ME TO FIND
OUT IS THAT 20% OF THE PEOPLE
GETTING ZYPREXA. AT LEAST IN OUR
CLAIMS DATA. WERE PEOPLE THA WERE OVER 65. FOR WHOM IT WAS
OFF-LABELED.
NOT ONLY THAT.
MOST OF THESE PEOPLE HAD NEVER.
IN THE DATA THAT WE HAD.
HAD EVIDENCE THAT THEY WERE
SCHIZOPHRENIC OR BIPOLAR.
THEY TAUGHT THEM TO SAY.
"DOCTOR. WELL. DON'T YOU HAVE
ANY PEOPLE THAT COME IN AND
COMPLAIN. 'WELL. YOU KNOW,
FINANCIALLY. WE'RE DOING--WE'RE
HAVING A DIFFICULT TIME. AND I'M
JUST STRESSED OUT RIGHT NOW'?
ANYBODY WHO SAYS THAT WHO USES
THESE MAGIC WORDS LIKE "STRESS."
YOU CAN CONVERT THAT WORD INTO
"DELUSIONAL." OKAY?
YOU CAN CONVERT ANY ANXIETY THEY
HAVE INTO A DELUSIONAL BEHAVIOR.
AND AS LONG AS YOU PU "DELUSIONAL" IN YOUR RECORD.
THEN YOU CAN QUALIFY FOR PAYMEN BY A GOVERNMENT ENTITY LIKE
MEDICAID AND MEDICARE."
THE REASON THAT DRUG
COMPANIES PRAY ON MEDICAID IS
THE SAME REASON THAT BANK
ROBBERS ROB BANKS.
THAT'S WHERE THE MONEY IS.
AND THERE'S HUNDREDS OF MILLIONS
OF DOLLARS IN EVEN A RELATIVELY
SMALL STATE LIKE UTAH. WITH ITS
POPULATION OF 2.5 MILLION
PEOPLE.
"IF YOU DO THAT. WE WILL PAY
YOU TO GO ON A SPEAKING CIRCUI TO TELL OTHER DOCTORS HOW
EFFECTIVE THIS DRUG IS FOR YOUR
REGULAR PATIENTS."
WHAT QUALIFIES AS A SPEAKER IS.
IF THAT DOCTOR GOT ON THE PHONE
AND TALKED TO EVEN ONE OTHER
DOCTOR WHO WAS SCHEDULED TO TAKE
PART IN A TELEPHONIC CONFERENCE.
THEY WOULD GET A CHECK.
AND THERE WERE DOCTORS WHO WERE
GETTING A LOT OF CHECKS FOR
THAT.
I SUE DRUG COMPANIES.
I SUE THEM ON BEHALF OF
ATTORNEYS GENERAL.
I SUE THEM ON BEHALF OF
MEDICAID.
I'VE BEEN DOING THAT FOR ABOU SIX YEARS.
WE WERE REALLY THE FIRST SET OF
LAWYERS TO BRING AN ATTORNEY
GENERAL CASE TO TRIAL.
WE BOUGHT--BROUGHT THAT CASE TO
TRIAL IN ALASKA.
TWO WEEKS INTO TRIAL AND SHORTLY
BEFORE THE JURY OUT--WENT OUT.
WE SETTLED THE CASE FOR
$15 MILLION.
I SETTLED UTAH'S CASE AGAINS THE SAME DEFENDANT.
WHICH IS ELI LILLY. MAKER OF THE
DRUG ZYPREXA.
I SETTLED THE UTAH CASE FOR
$24 MILLION. IDAHO CASE FOR
$13 MILLION. WEST VIRGINIA
VERSUS ELI LILLY. WHICH SETTLED
FOR ABOUT $24 MILLION.
MANY OF THE ATTORNEY GENERALS
TURNED US AWAY BECAUSE IT'S
UNPOPULAR FOR THEM TO SUE BIG
BUSINESS.
NOT ONLY IS IT UNPOPULAR.
BUT IT'S VERY EXPENSIVE.
THE GOVERNMENT PURSE WAS BEING
DEPLETED IN ENORMOUS AMOUNTS
BY THESE DRUG COMPANIES THA WEREN'T PLAYING FAIR AND THE
GOVERNMENT HAD THE RIGH TO RECOVER THAT MONEY.
THE ISSUE WAS--IT'S WHETHER
OR NOT THERE WAS EXCESSIVE COSTS
OR EXCESSIVE INAPPROPRIATE USES
OF ZYPREXA IN THE MEDICAID
POPULATION.
THE FDA APPROVED THE USE OF
THAT DRUG FOR PEOPLE BETWEEN THE
AGES OF 18 AND 65 ONLY IF THEY
HAD BEEN DIAGNOSED WITH BIPOLAR
DISORDER OR SCHIZOPHRENIA.
IN OTHER WORDS. THEY HAD NO
CLINICAL CONDITION IN THEIR PAS THAT WOULD INDICATE WHY THEY
SHOULD GET ZYPREXA.
SECONDLY IS. IS THESE PEOPLE HAD
A INCREASED PROPENSITY FOR
GETTING DIABETES.
I LOOKED. THEN. AT WHAT THE COS WOULD BE TO OUR PROGRAM AND
NOTED THAT. BESIDES THE PILL
COSTS. THERE WERE ADDITIONAL
HEALTH CARE COSTS. MAYBE UP TO
$70 MILLION FOR OUR PARTICULAR
STATE FOR THE USE OF THIS
MEDICATION.
THESE ARE PRIMARY CARE
PHYSICIANS THAT THEY'RE SELLING
ZYPREXA TO.
THEY'RE NOT GOING TO
PSYCHIATRISTS WHO ARE TREATING
THE PEOPLE THE FDA HAS APPROVED
ZYPREXA FOR.
ONLY PSYCHIATRISTS ARE TREATING
PEOPLE WITH BIPOLAR DISORDER
AND SCHIZOPHRENIA.
THE JUSTICE DEPARTMENT THA PROSECUTES THESE CASES HASN' FINED THE COMPANIES ANYWHERE
NEAR AS MUCH AS THEY SHOULD.
IN OTHER WORDS. AS MUCH AS THEY
MADE. NOR HAS ANYONE EVER GONE
TO JAIL.
IF YOU JUST THINK ABOUT THE
CONSEQUENCES OF THIS CRIMINAL
ACTIVITY. A DOCTOR GETS
ILLEGALLY PROMOTED BY THE
COMPANY TO PRESCRIBE A DRUG THA THE DOCTOR MAY THINK HAS
BENEFITS THAT OUTWEIGH THE RISK.
THERE ISN'T ANY EVIDENCE FOR
THAT AT ALL.
THE DOCTOR PRESCRIBES THE DRUG.
A PERSON DIES BECAUSE THERE
REALLY WASN'T ANY EVIDENCE THA IT EVEN WORKED FOR THAT.
AND THERE WERE--THERE'S EVIDENCE
OF DANGERS.
ONE COMPANY. PFIZER. ONE OF THE
BIGGEST DRUG COMPANIES IN THE
WORLD. SOLD $1 BILLION A YEAR OF
A PARTICULAR DRUG. AND 90% OF
THE SALES WERE FOR OFF-LABEL
USE.
ILLEGAL. THEY WERE CRIMINALLY
PROSECUTED FOR IT BACK ABOU FIVE OR SIX YEARS AGO. BUT THE
FINE THEY PAID. WHICH SEEMED
LARGE--HUNDREDS OF MILLIONS OF
DOLLARS--WASN'T BIG ENOUGH TO
DETER THEM FROM DOING IT AGAIN.
AND IN SEPTEMBER OF 2009.
THE SAME COMPANY PAID THE
LARGEST CRIMINAL PENALTY EVER
PAID BY ANY UNITED STATES
COMPANY: OVER $1.2 BILLION FOR
ILLEGAL. CRIMINAL OFF-LABEL
PROMOTION.
THIS WAS A DELIBERATE SCHEME.
THEY KNOW HOW DEFENSELESS
MEDICAID AND MEDICARE ARE WHEN
IT COMES TO PAYING DRUG
PRESCRIPTIONS.
THERE'S SUCH AN ELABORATE
COMPUTER ORIENTED SYSTEM SET UP
FOR PAYMENT OF THESE MILLIONS
AND MILLIONS OF PRESCRIPTIONS
ACROSS THE COUNTRY BY PEOPLE ON
MEDICAID AND MEDICARE THAT I CAN'T BE INTERRUPTED.
THERE'S NO WAY FOR ANY WATCHDOG
TO SAY. "OH. WELL, YOU'VE
PRESCRIBED THIS TO SOMEBODY WHO
HAS NO BUSINESS TAKING IT."
MEDICAID WILL PAY WHATEVER I IS THEY CHOOSE TO CHARGE FOR
THEIR DRUGS.
SO ZYPREXA PRESCRIPTIONS COS SOMEWHERE BETWEEN $500
AND $1.000 A MONTH PER PERSON.
IT'S AN EXTRAORDINARILY
EXPENSIVE DRUG.
WHEN WE LOOKED AT THIS.
WE NOTICED THAT THERE WAS
A CONSIDERABLE INCREASE IN COST.
IN ADDITION TO THE COST OF
THE MEDICINE ITSELF.
NOW. THIS WAS PARTICULARLY
FRUSTRATING TO ME. BECAUSE
RECENTLY THERE'S BEEN EVIDENCE
THAT SOME OF THE OLDER
ANTIPSYCHOTICS--
ANTIPSYCHOTICS HAD BEEN AROUND
FOR 40 OR 50 YEARS--
WORK ALMOST AS WELL AS ZYPREXA.
SO HERE WE HAVE A GROUP OF
PEOPLE OVER 65 WHO ARE GETTING
A MEDICATION FOR ANXIETY OR TO
CALM THEM DOWN FOR WHICH
THE MEDICINE WAS NOT APPROVED.
AND IT'S COSTING A LOT OF MONEY.
INCREASING THE LIKELIHOOD
THAT THEY'LL HAVE DIABETES.
AND IN ADDITION TO THAT. THERE
ARE OTHER MEDICINES THAT THEY
COULD'VE USED THAT SEEM TO WORK
AS EFFECTIVELY.
BUT THE STATE IS PAYING FOR
IT. SO IT DOESN'T MATTER THA IT'S EXPENSIVE. AND IT DOESN' MATTER THAT THERE ARE OTHER
THINGS THAT ARE BETTER.
IT'S SORT OF LIKE A MODERN FORM
OF LOBOTOMY.
WHILE THE NURSES ARE COMPLAINING
LESS BECAUSE THE OLD PEOPLE ARE
LESS ACTIVE. IT'S KILLING THEM.
AND IT'S EXTREMELY EXPENSIVE.
OUR LOOK AT THE DATA SAID IT'S
EXTREMELY EXPENSIVE TO DIE.
SO WHAT HAPPENS IS. MEDICAID
WINDS UP PAYING FOR THE PERSON'S
FINAL ILLNESS.
SO IT'S A WIN-WIN FOR LILLY AND
FOR THE DOCTORS. BUT IT IS
A TERRIBLE LOSING PROPOSITION
FOR THE STATE.
WHAT WE FOUND OUT THROUGH THE
MEDICAID DATABASES OF THE STATES
THAT WE REPRESENTED WAS THA OVER 50% OF THE DRUG ZYPREXA WAS
PRESCRIBED OFF-LABEL FOR
UNAPPROVED USES BY THE FDA.
THIS IS OVER 50% OF THE DRUG
JUST IN THE MEDICAID POPULATION.
THERE'S NO DOUBT THAT AT LEAS THAT MUCH OF THE DRUG WAS
PRESCRIBED OFF-LABEL FOR PEOPLE
OUTSIDE THE MEDICAID POPULATION.
ALL RIGHT. NOW WE'RE GONNA
GET BACK TO OUR EARNINGS.
SPECIFICALLY DRUG EARNINGS.
ELI LILLY BEATING ANALYS ESTIMATES BY TWO PENNIES A SHARE
NOT COUNTING MONEY SET ASIDE FOR
FUTURE LEGAL SETTLEMENTS LINKED
TO THE ANTIPSYCHOTIC DRUG
ZYPREXA.
JOINING US FOR A CLOSER LOOK A THE COMPANY'S NUMBERS IS
JOHN LECHLEITER. CHIEF EXECUTIVE
OFFICER AT ELI LILLY.
HE COMES TO US FROM THE
COMPANY'S HEADQUARTERS IN
INDIANAPOLIS THIS MORNING.
JOHN. GOOD MORNING.
GOOD TO HAVE YOU BACK ON
MORNING CALL.
THANKS. CAROL. GOOD MORNING.
SO WHAT ARE THE HIGHLIGHTS
FROM THE QUARTER?
CAROL. WE HAD A VERY STRONG
QUARTER.
WE GREW OUR SALES 14%.
WE GREW OUR EXPENSES LESS THAN
THAT.
WE EXPANDED OUR GROSS MARGIN.
OUR NON GAP QUARTER TO QUARTER
COMPARISON. 14% GROWTH IN
EARNINGS PER SHARE.
MAKE IT TOO EXPENSIVE TO DO
IT IN THE UNSAFE WAY.
IF YOU SAY TO THE DRUG COMPANY.
"HEY. LOOK. YOU CAN MAKE
$4 BILLION WORTH OF PROFIT OU OF THIS IF YOU DO IT IN THE
UNSAFE WAY. BUT I'M ONLY GONNA
FINE YOU $1 BILLION."
WELL. THAT'S $3 BILLION WORTH OF
PROFIT.
WELL. IT CAN'T WORK THAT WAY.
IT'S GOT TO BE TOO EXPENSIVE TO
DO IT IN THE UNSAFE WAY.
THE FDA. THEY DON'T HAVE
THE MANPOWER.
THEY NEVER WILL.
THEY DO IT--THEY DO THE BEST JOB
THAT THEY CAN WITH WHAT THEY
HAVE. BUT AS ONE OF OUR EXPERTS
SAID. NOBODY CAN REVIEW A NEW
DRUG APPLICATION AT THE FDA.
BECAUSE NO HUMAN BEING CAN READ
THE WHOLE THING.
YOU CAN HIDE THE STUFF IN THERE.
BUT WHAT THE DRUG COMPANY NEEDS
TO KNOW BEFORE THEY EVER SUBMI THAT APPLICATION IS. THAT IF I
HIDE THINGS IN THERE AND THE
TRUTH COMES OUT. IT'S GOING TO
BE MORE EXPENSE THAN IT IS
WORTH.
OTHERWISE. NONE OF US ARE GONNA
BE SAFE FROM THIS BEHAVIOR.
YOU CAN'T LET THEM MAKE A NE PROFIT ON LYING.
YOU MAKE A NET PROFIT ON LYING.
YOU'RE GOING TO LIE.
AND IT'S THE LAWYER'S FAULT.
OKAY?
IT'S THE LAWYER'S FAULT.
WE INVENTED CORPORATIONS.
AND WHEN WE INVENTED IT.
WE DIDN'T GIVE IT A CONSCIENCE.
WE DIDN'T GIVE IT A SOUL.
YOU CAN'T PUT IT IN JAIL.
IT'S NOT A HUMAN BEING.
IT'S A MACHINE.
IT'S A LEGAL MACHINE.
WE INVENTED IT.
IT'S OUR FAULT.
BUT THE ONLY WAY TO KEEP THA MACHINE IN CHECK IS TO MAKE I TOO EXPENSIVE FOR THAT MACHINE
TO DO IT. BECAUSE THAT'S ALL THE
MACHINE UNDERSTANDS. AND THAT'LL
SOLVE THE PROBLEM.
I MEAN. WE--WE ARE SPENDING
FOR A LEVEL OF HEALTH CARE THA WE SHOULD BE ABLE TO HAVE I ALL.
INSTEAD. WHAT WE SPEND ON HEALTH
CARE BENEFITS THE INSURANCE
COMPANIES AND THE PHARMACEUTICAL
COMPANIES.
I THINK WE NEED TO CHANGE
MEDICAL EDUCATION.
WE NEED TO TRAIN MEDICAL
STUDENTS IN RESIDENCE SO THA THEY THINK ABOUT ADVERSE
EFFECTS. PROBABLY EVEN BEFORE
THEY THINK ABOUT THE DESIRED
EFFECT. BECAUSE ADVERSE EFFECTS
CAUSE PROBLEMS IN PATIENTS.
AND THAT'S COUNTER TO THE
PRINCIPLE THAT WE ALL HAVE
ABIDED--THAT WE ALL HAVE SWORN
TO WHEN WE GRADUATED. THAT IS.
"DO NO HARM."
AS MUCH AS I'M FOR SMALL
GOVERNMENT. WE'RE GONNA NEED
A MONITORING AGENCY.
BUT WE HAVE TO FIGURE OUT WAYS
TO ABSOLUTELY INSULATE THE
PEOPLE WHO MONITOR FROM THE
PEOPLE WHOM THEY'RE MONITORING.
WE CAN LOOK BACK AS FAR AS
PEOPLE LIKE ELVIS PRESLEY AND
ANNA NICOLE SMITH MORE RECENTLY
AND THEN GRADUATING INTO
HEATH LEDGER. COREY HAIM. PEOPLE
LIKE THIS DYING. AND THE ONLY
POSITIVE THAT'S COME OUT OF THIS
NEGATIVE IS THAT IT'S BROUGH SOME ATTENTION TO THE AMERICAN
PUBLIC THAT THIS IS A PROBLEM.
AND THE REALITY IS
IS THAT REGULAR PEOPLE.
NON-CELEBRITIES. ARE DYING EVERY
SINGLE DAY FROM PRESCRIPTION
PILLS--NOT FROM OVERDOSES.
NOT FROM PEOPLE TAKING IT FOR
FUN. BUT PEOPLE SIMPLY TAKING
THEIR MEDICATIONS EXACTLY HOW
THEIR DOCTOR TOLD THEM TO TAKE
IT. BUT THE COMBINATION OF
SLEEPING PILLS AND ANXIETY PILLS
AND NARCOTICS. THEY GO TO SLEEP.
AND THEY DON'T WAKE UP.
SO HOW DO WE STOP IT?
THE PROBLEM IS. WE HAVE A NATION
OF ADDICTS THAT ARE BEING
IGNORED.
THE ANSWER TO THE PROBLEM.
IN MY OPINION. IS NOT THE
GOVERNMENT.
IT'S NOT OTHER PEOPLE.
IT REALLY STARTS WITH THE
INDIVIDUAL BEING RESPONSIBLE
FOR THEMSELVES.
I THINK THAT EVERY PERSON SHOULD
HAVE THEIR OWN MEDICAL RECORD.
PERIOD.
YOU SHOULDN'T RELY ON YOUR
MEDICAL RECORD TO BE AT YOUR
DOCTOR'S OFFICE.
YOU SHOULD MAINTAIN YOUR OWN
MEDICAL RECORDS.
IF YOU HAVE AN MRI. GET A COPY
FOR YOURSELF.
THE BEST WAY TO SOLVE THIS
PROBLEM IS TO PREVENT IT FROM
HAPPENING IN THE FIRST PLACE.
IF A PERSON HAS TO HAVE SURGERY.
AND THEY'RE GONNA NEED A PAIN
PILL AFTER SURGERY--
YOU'RE GONNA HAVE AN ARTHROSCOPY
OF YOUR KNEE.
IT HURTS.
IT'S SUPPOSED TO HURT.
YOU'RE SUPPOSED TO TAKE SOME
PAIN MEDICINE.
MOST PAIN HAPPENS AFTER SURGERY
IN THE FIRST 72 HOURS. THE FIRS THREE DAYS.
SO IT'S FINE TO TAKE A STRONG
PAINKILLER FOR THOSE THREE DAYS.
BUT OFTEN WHAT YOU SEE IS.
DOCTORS WILL GIVE OUT 90 PILLS
OR 60 PILLS OR 120 PILLS FOR
A SURGERY THAT'S ONLY GONNA
REALLY HURT THE PERSON WHERE
THEY WOULD NEED THOSE PILLS FOR
MAYBE THREE OR FOUR DAYS.
IF YOU ONLY USE A FEW PILLS.
GET RID OF THE OTHER PILLS.
YOU DON'T WANT TO THROW THEM
DOWN THE TOILET.
PEOPLE SAY. "WELL. I FLUSH I DOWN THE TOILET."
WE'RE CONTAMINATING OUR WATER
SYSTEM. SO YOU DON'T WANT TO
FLUSH IT DOWN THE TOILET.
YOU WANT TO TAKE IT BACK TO YOUR
PHYSICIAN'S OFFICE.
AND THEY NORMALLY HAVE
A MECHANISM TO GET RID OF DRUGS
SAFELY.
DON'T LOOK--DON'T ACCEPT A PILL
FOR A PROBLEM.
SO IF YOU GO TO A DOCTOR.
AND YOU TELL THE DOCTOR THA YOU'RE HAVING HEADACHES. AND THE
FIRST THING HE DOES IS GIVE YOU
A PILL FOR HEADACHE--HE DOESN' EVEN ASK YOU WHAT KIND OF
HEADACHES. WHEN DID THEY START.
WHY DID THEY START.
YOU FIRST TELL THE DOCTOR.
"IS THERE ANY ALTERNATIVE OTHER
THAN THIS PILL FOR MY
HEADACHES?"
AND IF THE DOCTOR TELLS YOU NO.
IT'S TIME TO FIND A NEW DOCTOR.
YOU GOT TO PUSH
IN MY HAND
THAT WON'T LET UP
NO BRAKES
LIVING FAS NOT GIVIN' A FUCK
HIGH STAKES
I'M GONNA GET I 'CAUSE I'M A FIEND
SELL THE DEVIL MY SOUL
TO GET ME WHAT I NEED
GET ME A FIX
GET ME BACK INTO THE ZONE
JUST ONE MORE TRIP
UNTIL MY MIND GETS BLOWN
LEAVE ME ALONE
PRESCRIPTIONS FOR
THE SHIT I'M ON
GOT ME LOOKING
LIKE THE LIGHT'S ON
BUT NO ONE'S HOME
CHECK MY HEARTBEA RACING AT THE SPEED OF LIGH PERCOCET OR VICODIN
WILL SET YOU FREE TONIGH I TRIPLED UP ON EVERYTHING
I'M NOT BREATHING RIGH IT'S GOT A HOLD ON ME
AND IT MIGHT SEIZE MY LIFE
I AIN'T NEVER GIVE A FUCK
ABOUT SHI EXCEPT FOR CORPORATE DOCTOR
TRYING TO GET ME THAT FIX
I GOT A DRUG COCKTAIL
TO GET ME IN THE MIX
POP A PILL. KNEEL
AND KISS MY CRUCIFIX
AND I'LL PROBABLY
NEVER CHANGE
THE MORE I TRY
STOPPED TAKING THE
MEDICATION.
IT HAD SIDE EFFECTS THAT HAD
CAUSED ME NUMEROUS WHOLE BOUTS
OF PERSONALITY CHANGES THA CAUSED A BREAKUP WITH MY
FIANCEE.
I KIND OF JUST STOPPED
EVERYTHING. AND FOR ABOU 20 DAYS. WENT THROUGH
WITHDRAWALS AND THE WORS FEELING IN MY LIFE.
I WAS AN ADDICT.
I WAS TAKING THEM ALL THE TIME
FOR TWO YEARS.
I WAS TAKING EIGHT TO TEN A DAY.
AND MY BODY FELT LIKE I NEEDED
IT.
I HAD NO STRENGTH.
LIKE I WAS NOBODY.
I WAS REALLY SAD. CRYING.
OKAY.
I STARTED AT ONE PILL A DAY
FOR THE FIRST MONTH OR SO.
AND THEN IT SLOWLY PROGRESSED TO
TWO. AND THEN I ENDED UP AT THE
MOST--I ENDED UP TAKING ABOU SEVEN TO EIGHT PILLS A DAY.
AND I WAS SIFTING THEM ONTO
FOIL. AND THEN I WOULD SMOKE
THEM. OR SOMETIMES I WOULD SNIFF
THEM. AND IT JUST TOOK ME AWAY.
IT'D MAKE YOU FEEL MAYBE--
MAYBE A LITTLE EUPHORIC OR
SOMETHING. BUT I ALWAYS THOUGH I TOOK THEM FOR THE PAIN.
BUT I THINK I TOOK THEM MOSTLY.
LIKE THEY SAID. BECAUSE I JUS THOUGHT I NEEDED THEM.
I NEVER KNEW WHAT THESE
MEDICATIONS WERE OR. YOU KNOW.
THE LONG-TERM EFFECTS OF THEM.
IT'S SUCH AN EASY THING TO GE CAUGHT IN THIS VICIOUS CIRCLE.
BEING GIVEN PILLS EVERY MONTH.
YOU KNOW. RIDICULOUS QUANTITIES.
IS JUST LIKE YOU'RE NOT EVEN
YOU.
YOU'RE JUST A ZOMBIE.
STUCK ON THE MUSHROOMS
HALLUCINATING
LOCKED IN THE ROOM
GOING HEAD UP A SECOND
ADDICTED TO THEM PISTOLS
AND RUNNING MISSIONS
45 THE CASE
AND MAKING BAD DECISIONS
ADDICTED TO THROWIN' UP
MY BLESSING
I WAS DOWN TO DIE
FOR THAT SHI YOU CAN BE I'M ADDICTED TO THIS MUSIC
THAT SAVED MY LIFE
HELPED ME BECOME A MAN
AND GET MY SHIT RIGH AND I'LL PROBABLY
NEVER CHANGE
THE MORE I TRY
THE MORE I STAY THE SAME
I HATE TO LOOK IN THE MIRROR
'CAUSE ALL I SEE
SOMEBODY SPRUNG
THAT LOOKS ME
AND I CAN'T BREAK MY HABITS
I'M AN AMERICAN ADDIC [ gentle piano music ]
[ gentle piano music ]