You’re probably unaware of the many ways that Big Pharma manipulates you into accepting pills for everything. This discussion will tell you how it does that.
[1] The placebo effect manipulates you
Pharma does not tell you that the placebo effect and the power of suggestion play a very large role in the effectiveness of many drugs. For example, the placebo effect is recognized as an important factor in the effectiveness of pain pills, antidepressants, anti-anxiety drugs, blood pressure drugs, and drugs for cough, erectile dysfunction, irritable bowel syndrome, migraine, and Parkinson’s disease.
In clinical trials, Pharma usually compares its drug to a placebo, rather than to an existing drug. Surprisingly, the FDA often approves drugs which show only marginal benefit over a placebo. But if you factor in the adverse effects associated with the active drug, you might logically conclude that the placebo is the superior agent.
Doctors and Pharmacists Promote Placebo Power:
Marcia Angell, M.D. was formerly the editor-in-chief at The New England Journal of Medicine.
In her highly acclaimed book, The Truth About The Drug Companies, Angell writes (p. xviii-xix):
“I witnessed firsthand the influence of the industry on medical research during my decades at The New England Journal of Medicine. The staple of the journal is research about causes of and treatments for disease. Increasingly, this work is sponsored by drug companies. I saw companies begin to exercise a level of control over the way research is done that was unheard of when I first came to the journal, and the aim was clearly to load the dice to make sure their drugs looked good. As an example, companies would require researchers to compare a new drug with a placebo (sugar pill) instead of with an older drug. That way, the new drug would look good even though it might actually be worse than the older one. …As I saw industry influence grow, I became increasingly troubled by the possibility that much published research is seriously flawed, leading doctors to believe new drugs are generally more effective and safer than they actually are.”
Studies have shown that when a physician tells a patient “This drug is highly effective,” that patient is more likely to experience benefit from that drug in comparison to the doctor saying something like “I’m not sure whether this drug will help, but let’s give it a try.”
How much of the effectiveness of the pills pharmacists dispense is due to the placebo effect and the power of suggestion? How many of the conditions treated by the pills pharmacists dispense would be more logically addressed by dietary/nutritional and lifestyle changes?
Are pharmacists proud of the fact that the placebo effect accounts for much of the benefit that people obtain from many pills? Or are pharmacists embarrassed by the hocus pocus that the placebo effect represents? Is the power of suggestion more important with many pills than their intrinsic pharmacological activity?
[2] You’re manipulated by pill color
Pharma does not tell you that it gives much consideration to pill color. That is because pill color affects how patients feel about their medication. According to an article in The Atlantic (Tessa Fiorini Cohen, “The Power of Drug Color,” October 13, 2014), a pill’s hue can affect how it’s judged by patients, how it’s marketed, and even how well it works:
https://www.theatlantic.com/health/archive/2014/10/the-power-of-drug-color/381156/
“Blue pills…act best as sedatives. Red and orange are stimulants. Cheery yellows make the most effective antidepressants, while green reduces anxiety and white soothes pain. Brighter colors and embossed brand names further strengthen these effects—a bright yellow pill with the name on its surface, for example, may have a stronger effect than a dull yellow pill without it.”
According to an article in Science Daily (Inderscience Publishers. “Color and shape of pills affects how patients feel about their medication.” ScienceDaily. 19 January 2011):
https://www.sciencedaily.com/releases/2010/11/101115110959.htm
“According to recent research the color, shape, taste and even name of a tablet or pill can have an effect on how patients feel about their medication. Choose an appropriate combination and the placebo effect gives the pill a boost, improves outcomes and might even reduce side effects. Now, researchers at the University of Bombay, New Mumbai, India, have surveyed users of over-the-counter (OTC) medication to find out just how much the color of a tablet influences patient choice.”
Writing in the International Journal of Biotechnology, R.K. Srivastava and colleagues report that red and pink tablets are preferred over other colors.
…”Twice as many middle-aged people preferred red tablets as younger adults and more women chose red tablets as were chosen by men. Color seems to be integral component of an OTC product, the team says.
…”Patients undergo a sensory experience every time they self-administer a drug, whether it’s swallowing a tablet or capsule, chewing a tablet, swallowing a liquid, or applying a cream or ointment,” the team says. “The ritual involving perceptions can powerfully affect a patient’s view of treatment effectiveness.”
The researchers suggest that it might be possible to ensure that all the sensory elements of given medication work together to create positive perceptions that complement the medical attributes.
[3] You’re manipulated by the use of clever words
Pharma prefers the term “untoward effects” because it is less scary than “side effects” or “adverse effects.” Pharma prefers the peculiar term “polypharmacy” instead of the more revealing and honest term “overmedication.” Pharma prefers the benign-sounding term “medicines” instead of the baggage-laden term “drugs.” The latter often conjures up illicit street drugs.
In my opinion, the most loaded word in medical marketing is “may.” This term is used ad nauseam: Drug A may improve survival with cancer. Drug B may be effective against Alzheimer’s disease. Drug C may be effective against osteoporosis. Drug D may help you lose weight. Drug E may help you overcome shyness. Drug F may help your child’s school performance. Drug G may lessen your winter blues. Drug H may lessen your excessive handwashing. The use of the word “may” implies a likely probability whereas, in the real world, the benefit is probably marginal at best.
Pharma often seems to use language that is intended to intimidate or at least to impress the public. For example, the word “disorder” is often appended to words to make common behaviors appear to be serious medical conditions. Shyness is now “social anxiety disorder.” Excessive handwashing is now “obsessive-compulsive disorder.” Unruly or inattentive kids are now labeled with “attention-deficit hyperactivity disorder.” Winter blues is now “seasonal affective disorder.” Dissatisfaction with the appearance of one’s body is now “body dysmorphic disorder.”
Pharma does not tell you that much thought is put into choosing the brand names of drugs to help persuade you that the drug is effective. For example, Viagra, for impotence, implies the immense power of Niagara Falls. Levitra, for erectile dysfunction, levitates the penis. Lopressor lowers blood pressure. Lipitor lowers lipids. The acid suppressor Zantac consists of the popular letter “Z” plus the first five letters of “antacid.” Xanax, for anxiety, sounds a lot like “anxiety” and conjures up images of Xanadu, which Webster’s Dictionary defines as “an idyllic, exotic, or luxurious place.” Halcion, for insomnia, suggests “halcyon” which Webster’s defines as “calm, peaceful.” Lunesta, for insomnia, implies “lunar” (moon) because we often associate the moon with sleep. Librium, for anxiety, restores “equilibrium.” Procardia is “pro” (for) + “cardia” (heart). Propecia treats alopecia (male pattern baldness).
Are you blown away by the obtuseness of generic drug names? My rough guess is that generic drug names are, on average, about 40% longer than their brand name counterparts. My conclusion is that Pharma likes it that way so that pharmacy customers will develop brand loyalty. The adoption of long generic names that are incredibly difficult to spell and pronounce causes people to throw up their hands in exasperation and latch on to the much simpler brand names.
For example, here is a partial list of new drug approvals for 2021 from drugs.com. If the people who name drugs are able to create unique brand names that are, say, 40 percent shorter than generic names, can anyone seriously deny that generic names are intentionally cumbersome and unwieldy to force people to remember the brand names of drugs?
New drug approvals (2021) from drugs.com
https://www.drugs.com/newdrugs.html
- Livmarli (maralixibat)
- Qulipta (atogepant)
- Opzelura (ruxolitinib)
- Tivdak (tisotumab vedotin-tftv)
- Byooviz (ranibizumab-nuna)
- Exkivity (mobocertinib)
- Trudhesa (dihydroergotamine mesylate)
- Invega Hafyera (paliperidone palmitate)
- Skytrofa (lonapegsomatropin-tcgd)
- Korsuva (difelikefalin)
- Welireg (belzutifan)
- Nexviazyme (avalglucosidase alfa-ngpt)
- Saphnelo (anifrolumab-fnia)
- Bylvay (odevixibat)
- Rezurock (belumosudil)
[4] You’re manipulated by the term “relative risk reduction”
Pharma almost always uses “relative risk reduction” rather than “absolute risk reduction” even though the latter is a more honest and meaningful term. Drug commercials do not explain the huge difference between the two. Pharma routinely cites relative risk reduction to make the drug look better. Citing absolute risk reduction very often shows that the drug’s benefit is surprisingly small.
For example, here is an explanation of relative risk reduction vs. absolute risk reduction in relation to the cholesterol-lowering drug atorvastatin (Lipitor) (“How Did FDA Commissioner Hahn Confuse the Statistics?” The People’s Pharmacy, September 08, 2020):
“So, if you had 100 people taking atorvastatin for a year and another 100 people taking a look-alike inactive placebo pill for a year, at the end of the year two of the atorvastatin (Lipitor) takers had experienced heart attacks. Compare that to three of those swallowing placebo pills. What is the difference between them? One fewer person per 100 who had a heart attack in the Lipitor group. So the absolute risk reduction is one percent. Now, take that one person, divide it by the number of people who had heart attacks in the placebo group, and you get 1/3, or about 33 percent. That is the relative risk reduction. You can see why relative risk statistics are more appealing but also more confusing than absolute risk statistics.”
[5] You’re manipulated and lulled into a false sense of security about the potential for commonly-prescribed pharmaceuticals to actually cause cancer
Pharma often downplays the significance of adverse effects that occur in lab animals exposed to pharmaceuticals. Pharma implies that rats, mice, guinea pigs and dogs are such lowly and unimpressive creatures in comparison to the majestic human being. For example, Pharma does not tell you that many commonly prescribed drugs cause tumors or cancer in lab animals and, in some cases, in humans. Pharma often implies that side effects occur only in lab animals given huge doses, far greater than humans receive.
In Prescription for Disaster (NY: Simon & Schuster, 1998), Thomas Moore says that tumors often develop in lab animals at doses that are comparable to human doses on a pound-for-pound basis.
“With prescription drugs…animal cancers are often seen near the comparable human dose. This is because animals can rarely tolerate unrealistically large amounts of potent prescription drugs. With pesticide testing, animals may not be able to tolerate an enormous dose, but humans would be exposed to minute trace amounts on fruits, vegetables, or other produce. However, humans typically ingest a drug continuously for many years. Thus, when prescription drugs flunk their animal cancer tests, it is often at exposures in the neighborhood of a typical human dose over time. For example, salmon calcitonin, now being promoted as a long-term treatment for osteoporosis in older women, caused cancer in both rats and mice at lower doses than the manufacturer recommended for humans. The aggressively marketed new calcium channel blocker Plendil caused cancers in animals at 2.8 to 28 times the human dose in two years’ time. A typical patient would take Plendil for many years, and thus would likely exceed the exposure that caused cancer in rats. The epilepsy drug Depakene produced tumors in rats and mice at less than the human dosage.” (pp. 97-98)
“Sometimes drugs get a clean bill of health on cancer for a dangerous reason: They are too toxic for the animals even at the human dosage. For example, none of fourteen anti-inflammatory painkillers tested caused cancer in animals. However, the animal tests had to be conducted at unrealistically low doses because the drugs were so toxic to the gastrointestinal tract and kidneys—just as they are in humans. For example, Orudis was so toxic to mice that they could tolerate only half the comparable human dose. The animal tests for Anaprox, or naproxen, were only at 23 percent of the human dose because of the same toxicity problems.” (p. 98)
[6] You’re manipulated by the design of clinical trials
Pharma does not tell you that clinical trials usually involve only 2,000 to 3,000 subjects and for shorter periods than you would assume. The incidence of adverse effects in clinical trials does not reflect the real world. Volunteers are usually younger and healthier than people who take the drug in the real world. Pharma does not tell you that, in clinical trials, most drugs are compared to placebo rather to an active drug.
[7] You’re manipulated into thinking that the FDA is an effective watchdog
Pharma does not tell you that it pays 65 percent of the FDA’s drug regulatory budget. According to an official FDA publication (“FDA At A Glance,” U.S. Food & Drug Administration, Office of the Commissioner, Nov, 2020), “Human drugs regulatory activities account for 33 percent of FDA’s budget; 65 percent of these activities are paid for by industry user fees.”
The public is not told that this leads to a situation where FDA employees might feel that they work for or are beholden to Pharma rather than the American people. This is called regulatory capture where the industry that is supposed to be regulated ends up controlling the regulator.
Pharma does not tell you that FDA advisory committees very often consist of a disproportionate number of advisors who work for Pharma and thus have a powerful conflict of interest.
Pharma will not admit that it takes far more damaging information than the public suspects to remove a drug from the market. For example, in our pharmacy magazines, pharmacists frequently read about suspected hazards associated with some drugs for many years before the FDA finally recommends the removal of those drugs from the market. In the interim, many pharmacists ask themselves, “Why is this drug still on the market?”
[8] You’re manipulated by the use of surrogate endpoints
Pharma does not tell you that it uses surrogate endpoints or surrogate markers (like initial tumor response to anti-cancer drugs) rather than more meaningful endpoints (like a decrease in all-cause mortality). For example, just because a drug causes a favorable initial response (e.g., shrinking of a tumor) does not mean that the drug necessarily prolongs life or decreases all-cause mortality. Similarly, just because a drug decreases blood pressure, cholesterol or blood sugar (in type 2 diabetes), etc., doesn’t mean that the drug decreases all-cause mortality. Even though a drug may do an impressive job in lowering these readings doesn’t mean that the drug doesn’t wreak such havoc on the body that all-cause mortality actually increases.
[9] You’re manipulated by the term “safe and effective”
Pharma doesn’t tell you that the FDA’s definition of “safe and effective” is far different from the layman’s definition. Pharma does not tell you that FDA drug approval does not guarantee safety or that bad side effects won’t emerge after the drug is on the market. After all, the words “safe and effective” do not coincide with the layman’s definitions of those two words. Does a drug that potentially causes aplastic anemia, agranulocytosis, thrombocytopenia, or tumors in lab animals meet the layman’s definition of safe and effective
[10] You’re manipulated by adorable cartoon characters in drug commercials
Surely the lovable cartoon characters in drug commercials on TV imply that the drugs are very benign. The subliminal message is that pharmaceuticals are funny, entertaining, adorable and benevolent.
Pharma has created an orgy of absurd marketing with commercials on TV featuring a talking turkey to sell the smoking cessation drug Chantix, a talking owl to sell Xyzal for allergies, an animated bumble bee (voiced by actor Antonio Banderas) to sell Nasonex for allergy symptoms, a talking mucous-like creation to sell Mucinex for nasal mucous, a talking gremlin to sell Lamisil for toenail fungus, and a hard-to-describe cartoon character with bulging eyes to sell Xiidra for dry eyes.
[11] You’re manipulated into thinking that the human body is a machine
Pharma implies that the human body is a machine rather than a part of the natural world. If the human body were portrayed as part of the natural world, we would not want to put synthetic chemicals (pharmaceuticals) into our bodies. If, on the other hand, the human body is portrayed as a machine, we are less likely to worry about harming our body with synthetic chemicals.
[12] You’re manipulated into believing Pharma’s simplistic theories about the human body and disease causation
–Pharma portrays the chemical imbalance theory of depression as if it a were fact. In reality, there exists a tremendous body of medical literature that refutes this simplistic theory which dismisses psychology and psychoanalysis to make way for pills.
–Even though cholesterol is essential for the functioning of every cell in the human body, Pharma portrays cholesterol as inherently pathological.
–Even though stomach acid is essential to digest food and to kill pathogens in food, Pharma portrays stomach acid as an error in human evolution, and as something that must be counteracted with antacids, acid blockers, and proton pump inhibitors.
–Pharma has a simplistic view of fever as a disease that must be counteracted with drugs like acetaminophen or ibuprofen. In fact, fever is essential for fighting infection.
–Pharma views diarrhea as a disease process rather than as a protective mechanism to remove microorganisms or other noxious substances from the intestines.
–Pharma apparently did not learn from past drug disasters like the debacle with estrogen replacement therapy. Now Pharma is pushing testosterone replacement therapy in men as if declining testosterone with age is an error in human evolution. In fact testosterone supplementation can cause prostate cancer in rats and may be linked to cardiovascular disease in men.
–Pharma has a simplistic explanation for cancer based on molecules, cells, viruses genes, and aging. Pharma won’t admit that most cancers are preventable diseases of modern civilization. That is because the treatment of cancer is big business.
Pharma does not want you to know that The Merck Manual (17th edition, pp. 2591-2592) essentially states that up to 90% of cancer is preventable:
“Environmental or nutritional factors probably account for up to 90% of human cancers. These factors include smoking; diet; and exposure to sunlight, chemicals, and drugs. Genetic, viral, and radiation factors may cause the rest.”
[13] You’re manipulated into thinking that me-too drugs are actually significant therapeutic advances
Pharma promotes me-too and copy-cat drugs as if they are of the same importance as the discovery of antibiotics and the isolation of insulin.
Marcia Angell, M.D., former editor-in-chief of The New England Journal of Medicine, writes in her highly acclaimed book The Truth About the Drug Companies (New York: Random House, 2004, pp. xvii-xviii):
“[The pharmaceutical industry] over the past two decades has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the FDA, academic medical centers, and the medical profession itself.”
[14] You’re manipulated by images of happy people smiling while the announcer lists adverse effects during drug commercials on TV
To divert viewers’ attention from the long list of adverse effects at the end of drug commercials, Pharma intentionally uses images of happy families smiling and having fun on sunny days with the family pet. In my opinion, the TV screen should display the long list side effects on a black background with white text. Of course, that will never happen because of Pharma’s immense influence over Congress.
[15] You’re manipulated by the absence of information about disease prevention in drug commercials
The implication is that little if anything is known about disease prevention so there is no alternative to widespread use of pharmaceuticals. Pharma will never tell you that most of the prescriptions pharmacists fill are for preventable diseases of modern civilization. In my opinion, drug commercials should be required to begin with a meaningful and substantive discussion of what is known about preventing the condition being discussed.
Pharma will never admit that prevention is better than pills. Pharma will never admit that food is an extremely important determinant of health. Pharma will never admit that most of the prescriptions pharmacists fill are for preventable diseases of modern civilization. Pharma will never admit that people experience side effects in the real world at a much higher frequency than reported in clinical trials.
In conclusion, Big Pharma has, in my opinion, morphed into a massive marketing machine. Pharma views drug commercials as a blank canvas onto which any reality can be constructed. Marketing is what drives pharmacy today, not science.
Dennis Miller, R.Ph. is the author of The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.
