May 31, 2001

11:47 AM

US drug patients vs. the worldin AIDS crisis. Brazil is making generic AIDS medicine based upon existing drugs created (and of course patented) by US drug companies. the catch? they are giving the drugs away FOR FREE. US Drug companies want their money. the UN agreed ,52 in favor and 1 not in favor, for brazil's strategy for dealing with the AIDS crisis. guess who opposed.
posted by Qambient (38 comments total)

I think both sides have a case here, unfortunately. As much as I'd prefer the pharmaceutical companies not to price gouge, and as bogus as I think the patent system has become (Amazon.com patenting 1-click ordering, TiVo patenting "the ability to record one program while viewing another"), these companies' patents do appear to be being violated, and that IS illegal, whether I think it should be or not.

However, if you read up on this, there appears to be a provision in Brazilian law (and many other countries, it would seem) where in case of emergency certain laws can be sidestepped (sort of a martial law kinda thing, I guess), and I certainly think there's a solid case to be made for modifying a system to prevent an entity from scoring a major, major profit at the cost of many lives. Though some will argue AIDS in Brazil isn't a crisis, it sounds like the only reason it isn't a crisis is precisely because they're doing this.

People before profits . . . but it'd be nice not to be forced to violate patents in doing so.
posted by drywall at 12:00 PM on May 31, 2001

As far as I can recall, drug companies are "companies," and the main impetus of a company is to make a profit for its shareholders. Without profits, no more new drugs. A company will act in its own interest. If a company's investment in R & D is unlikely to ever produce profit greater than the investment, that investment will not be made unless the risk can be ameliorated elsewhere within the balance sheet.

That said, I too think the drug companies are shooting themselves in the foot, at the very least public relations wise. Why not give up some drugs now and gain a country full of customers later? At the same time, I assume they think that to give in on these drugs will invalidate any claims to patent they'd have or need later on, at which point we are back to square one. Those clamoring for drugs might do well to remember that, as aspirin has about as much effect on AIDS as cherry koolaid.

I take prescription drugs, and I pay for them. I also own stock in more than one pharmaceutical company. With those caveats, then:

(a) why do AIDS patients in Brazil rate higher on the free drug scale than me or my grandparents?

(b) why do AIDS drugs command such publicity, but diseases that affect far more people - heart disease, cancer, etc. - and their concommitant treatments go unmentioned?

(c) do the people who demand free drugs really believe that a company that is forced to give away its products will remain a company for very long?

This is not, I suspect, the simple "people vs. profit" argument that is often made.
posted by UncleFes at 12:46 PM on May 31, 2001

decent medical coverage in brazil is reserved for the rich, and your typical citizen with aids is living off of less than 500 bucks a month.

the only condoms you can get in a medium-sized brazilian city come in little boxes of 3 up by the cashier and are no-frills. the decrepid, yellowed boxes they're sold in make it painfully obvious that no one is actually buying them. pre-marital sex is frowned upon, and if you're getting yours, you're getting it in the closet (catholics, sigh).

it becomes clear that the country's problem with aids runs much deeper. while not the answer in the long-term, free drugs will at least help a little.
posted by sarelicar at 12:50 PM on May 31, 2001

The cure, no pun intended, is worse than the disease. When the next AIDS comes along, will the pharmaceutical companies devote huge amounts of money and brainpower into research for treatment? Or will they look to places like Brazil and South Africa - whose cultural foibles have more to do with their health problems than does access to effective drugs - and say, "we're going to sit this one out"?

If I was an executive with the World Health Organization, I'd be VERY nervous about the possibility of that eventuality.
posted by UncleFes at 1:03 PM on May 31, 2001

Have you ever downloaded a copyrighted song from napster? or used pirate software?

people all over the world break copyright and patent laws everyday for mere pleasure or to save a little money.

AIDS is a pandemic, pandemic \Pan*dem"ic\, a. [L. pandemus, Gr. ?, ?; ?, ?, all + ? the people: cf. F. pand['e]mique.] Affecting a whole people or a number of countries; everywhere epidemic Heart disease and cancer are not, And AIDS is a virus, and contagious. How can that possibly compare? Because it is a pandemic it falls into the category of a public health issue, and i personally think it is pretty cool that Brazil has done this thing that so threatens the profit margins of US manufacturers.
posted by th3ph17 at 1:48 PM on May 31, 2001

It's not simple a matter of profit vs. no profit. It's a matter of HOW MUCH profit.
posted by drywall at 1:51 PM on May 31, 2001

It gets better. The FDA currently guarantees 7 years of competition protection for drugs developed in the US in some conditions. For example, there is an interferon therapy marketed in the United States for people who suffer from MS. There is a newer therapy available in Europe, Canada, and everywhere else under the sun, and some evidence that this newer therapy is more effective. However, it's not available in the US because the FDA won't allow competition with the first therapy until 2003.
posted by faisal at 1:59 PM on May 31, 2001

"i personally think it is pretty cool that Brazil has done this thing that so threatens the profit margins of US manufacturers."

:) Then you will similarly think it cool when, when the next pandemic rolls around, the pharmaceutical companies - like Napster - are gone. No mp3's today, no pandemic drugs tomorrow.

See you in the afterlife, th3ph17.
posted by UncleFes at 2:03 PM on May 31, 2001

do you have a site with more info on that story faisal?
posted by Qambient at 2:03 PM on May 31, 2001

I'm sure this decision in Brazil will go over very big on MeFi due to its rampant knee-jerk anti-corporatism. The fact is, however, that innovation (including innovation in pharmaceuticals) is driven by profit motive. By violating the rights of U.S. patent holders in the name of fighting what is certainly a frightening (but not the most fatal by any means) disease, Brazil is making the situation worse worldwide by hindering the development of future drugs.

Furthermore, those of you who think it's acceptable to limit the amount of profit earned by pharmaceutical companies are in fact arguing for most obstacles in the way of future drug development as well.
posted by ljromanoff at 2:07 PM on May 31, 2001

Hear hear, ljromanoff.
posted by UncleFes at 2:11 PM on May 31, 2001

UncleFes:
(c) do the people who demand free drugs really believe that a company that is forced to give away its products will remain a company for very long?

You've got it subtly (but importantly) wrong. The drug companies who own these patents are not being forced to give away their products for free. The drugs in question are being manufactured by Brazilian drug companies, who are being paid for their products.

A patent is a government-granted monopoly on the manufacture of a certain item. Brazil is refusing to enforce such a monopoly in the specific case of these AIDS drugs. The American drug manufacturers who own the patents are upset not because they are forced to give away their products, but because they are forced to compete with Brazilian manufacturers in an open market.

-Mars
posted by Mars Saxman at 2:21 PM on May 31, 2001

The summary being given is, unfortunately, useless, because there are a number of issues that determine Brazil's patent restrictions. Prior to becoming a TRIPS signatory -- TRIPS being the WTO's intellectual property agreement -- Brazil's laws are all that matter, and Brazil didn't previously allow pharmaceutical patents. So, barring an international treaty that would override Brazillian law, those older drugs are given no patent protection in Brazil. (The analogy would be, say, someone in Europe trying to enforce copyright on a font in the United States; the U.S. just doesn't acknowledge copyrights on fonts, as far as I know.) The Brazilian Patent Office is holding that TRIPS isn't retroactive, although the U.S. disagreees. Further, TRIPS here's a lengthy post of mine from a previous discussion regarding South African patent struggles.)

I know Brazil had discussed compulsary licensing of drugs developed after becoming a TRIPS signatory -- this would violate TRIPS, unless they declared a national emergency or jumped through the hoops that TRIPS provides. Since the Wired piece doesn't say what drugs are being discussed, it's hard to determine who, legally, is in the right here, or even what cases are being discusssed.

By violating the rights of U.S. patent holders in the name of fighting what is certainly a frightening (but not the most fatal by any means) disease, Brazil is making the situation worse worldwide by hindering the development of future drugs.

Ignoring your broader statements about the profit motive, Lance, Brazil's national sovereignty means that unless they're violating a treaty on intellectual property that they've agreed to, they're entitled to do whatever they want regarding U.S. patents. Those are American patents, not Brazillian ones.
posted by snarkout at 2:29 PM on May 31, 2001

Sigh:

Further, TRIPS explicitly allows for compulsary licensing in the event of a national emergency. (Thanks to the incredible snappiness of MeFi at its new home, here's a lengthy post of mine from a previous discussion regarding South African patent struggles.)
posted by snarkout at 2:30 PM on May 31, 2001

It's subtler still, since aren't the Brazilian manufacturers basically taking unfair advantage of the years of work and billions of dollars sunk into these drugs by the US companies? Or did they develop these drugs independently of the US companies? I suspect the former. That means the Brazilian companies are starting with a extraordinarily large head start. Hardly "competition."

In any case, it won't affect the result: a company that cannot make a profit off R&D will discontinue R&D. Companies live or die by profits. Here, that means no new drugs.
posted by UncleFes at 2:37 PM on May 31, 2001

ah...you misplaced the order of meanings in my pseudo analogy. The recording industry would be akin the the pharmaceutical companies...not napster. And it is napster going away [mostly] not them.
posted by th3ph17 at 2:44 PM on May 31, 2001

I've read two articles in the last couple weeks that quoted US drug company researchers. In both cases they said the drugcos are already putting the breaks on some new AIDS drug research, not only because the chances of them ever making a profit on them is rapidly declining, but also because AIDS drug manufacturers are rapidly becoming the tobacco companies of the 2K0s: Automatic targets of organized politically-based hate. To make these drugs at all is now a guarantee of being the constant target of troublemaking activists, horrible press all over the world, etc etc. And there are no companies in the world willing to put up with that sort of a PR disaster unless the potential profits are humongous, which they aren't for AIDS medications even under the best of circumstances.

Result? When new strains of HIV start spreading that are resistant to the current generation of drugs, there's probably not going to be much of a new generation available at all.
posted by aaron at 2:45 PM on May 31, 2001

breaks = brakes. Feh.
posted by aaron at 2:47 PM on May 31, 2001

"The recording industry would be akin the the pharmaceutical companies...not napster. And it is napster going away [mostly] not them."

But the recording companies weren't producing a valuable service, nor did they invest billions in mp3 research.

We need a new analogy, I think :)
posted by UncleFes at 2:51 PM on May 31, 2001

3 in the afternoon with no coffee...thats the best i can do for now as far as analogies go...wait for someone more articulate.

aaron...the politically-based hate, which direction is that coming from? or it is more than one?
posted by th3ph17 at 3:14 PM on May 31, 2001

ljromanoff:
Keep in mind that much of the groundbreaking work that drug companies have taken credit (and patents) for and profit from has actually been done by government researchers using tax dollars. (warning, NYTimes archive link, might not work)
posted by feckless at 3:59 PM on May 31, 2001

Another thing worth considering: Although the costs of R&D are what all the companies talk about needing to recover, the majority (by a pretty whopping percentage) of the money spent by pharmaceutical companies to bring a drug to market is for advertising and branding, not for research or drug trials.
posted by ToasterKing at 4:12 PM on May 31, 2001

I have no problem with drug companies not spending R&D money on AIDS. Personally, I think pharmaceutical development is too important a matter to be left to the free market. Let's not forget many of these companies developing AIDS medications only did so after government urging and R&D assistance.

Leaving development solely to private corporations motivated by profit (rather than the public health) has a lot of problems. It means they'll only develop drugs if they can maintain a patent, ensuring they make a tidy profit off their product and keeping it priced out of the hands of many who may badly need it. Second, it means they concentrate disproporionate amounts of energy on developing drugs for conditions suffered by the wealthey rather than by the poor, as the wealthy are the ones who can afford to give the drug companies money.

Particularly with virulent, contagious diseases like AIDS, drug availability is unquestionably a matter of public health, which even Milton Friedman would admit the free market isn't well-equipped to do (the free market excels at generating wealth, not at meeting pure public needs). I would much rather see drug development funded by the government, allowing the public health as whole to be the main motivator, rather than profit.

I say we take the $60 billion+ earmarked for national missile defense (which I presume is motivated by a desire to let Americans lead happy, lengthy lives) and spend it on creating a quasi-governmental drug development agency that seeks simply to break even and to work for the public good, rather than for profit. It would certainly do more direct good for more Americans than any NMD, as more drugs meeting more people's needs could be offered at lower cost to those who need them.

There aren't many industries where the public need is so important that government control would work better than free market mechanisms, but there are a few. I would contend that pharmaceutical development is one of them.
posted by drywall at 4:50 PM on May 31, 2001

I would much rather see drug development funded by the government, allowing the public health as whole to be the main motivator, rather than profit.

No, then the main motivator becomes getting money out of the government.
posted by kindall at 4:56 PM on May 31, 2001

ljromanoff:
Keep in mind that much of the groundbreaking work that drug companies have taken credit (and patents) for and profit from has actually been done by government researchers using tax dollars. (warning, NYTimes archive link, might not work)

Of course some of the work has been done by govt. scientists - if the govt. is giving out tax money scientists, like anyone else, won't turn it down. Some has also been done by both private and public universities - that not the point. As someone who worked for a non-profit scientific foundation for several years, I can tell you that the majority of cutting edge science is done by industry - although certainly govt and academia have a role as well.
posted by ljromanoff at 5:34 PM on May 31, 2001

I have no problem with drug companies not spending R&D money on AIDS. Personally, I think pharmaceutical development is too important a matter to be left to the free market.

So, there's an "importance" threshold where the govt. needs to step in? Off the top of my head, I can think of at least three things more important that drug research: food, clothing, and shelter. Do you want to nationalize all the clothing stores, supermarkets, and every house and apartment in the country?

Second, it means they concentrate disproporionate amounts of energy on developing drugs for conditions suffered by the wealthey rather than by the poor, as the wealthy are the ones who can afford to give the drug companies money.

This makes no sense. First of all, can you name me some disease that only affects the rich? Secondly, the wealthiest companies on earth (Microsoft, Wal-Mart, General Motors) did not get that way catering to the wealthy, but instead by catering to the lower and middle classes. Why? Because although each consumer in these classes has less money, there's a lot more of them. Drug companies make money by making drugs lots of people can afford, not by making drugs only a few can. And besides, even if what you believe is true, drug patents don't last forever - in fact they're quite short - which means that even if a drug company does create a drug expressly for the wealthy (as absurd as that is) it will soon become a generic that anyone could buy.
posted by ljromanoff at 5:42 PM on May 31, 2001

Listen, if drug companies were interested in the public good, they'd be spending all of their time working on drugs for diseases like AIDS and syphilis. Instead we get stuff like Propecia and whatever that toenail-fungus drug was called.

Are these drugs expressly for the very wealthy? Are upper-middle-class men the only ones who suffer from hair loss? No, but they're the only ones who have the dispoable income to bother paying for a drug to stop it. These drugs aren't developed out of a pressing public need. The aim isn't to make drugs folks living below middle-class. The most profitable point on the curve for drug companies is not at the bottom selling huge volumes of cut-rate drugs to as many people as possible: it is is the middle where demand is moderate and prices are high, but not too high. High R&D costs (among other factors) create a barrier to entry, turning the market into an oligopoly, not perfect competition, and this creates a market aimed not at the lowest price for the greatest number. Take a basic econ class if this concept is foreign to you.

Microsoft does not make products that cater to the lower class or lower middle classs either. Check the stats: very few of those people have computers. They aim in the middle.

Similarly, no automotive company targets the lower class, either. The bottom-of-the-line Ford Festiva-types have the smallest profit margins of any vehicles type, luxury cars the highest. If you're the CEO of General Motors, which kind of car are you going to make and market? You'd be a bad CEO if you didn't aim at the upper crust. In fact there's a lot of evidence to suggest that the only reason companies like GM make the smaller cars with the minimal profit margins is because the government forces them to, due to fuel mileage requirements.

Do I want to nationalize food and clothing stores? Hmm... let me think, how much of the supermarket industry is driven by R&D that requires intellectual property law in order to be profitable? Gee, not much. Same goes for clothes: Of the three companies ljromanoff mentioned, only one can be said to target lower and lower-middle class folks: Wal-Mart. Why?

Consider the nature of the product. Drugs are a totally different industry than food, shelter, or clothing. Drug treatments aren't scalable. Drug companies can't develop and market one AIDS drug that's cheap and works okay, one that is slightly more expensive and works a bit better, and one that's really expensive. Chemistry doesn't really work that way, R&D budgets don't scale in a matter allowing such products. Markets for food, shelter and clothing can.

There's a big difference.
posted by drywall at 9:11 PM on May 31, 2001

...and now that I've defended my side, let's hear yours. I'm dying to hear your case on how the drug companies in fact do act primarily in the interest of public good.

In addition to responding to my comments, I'd be interested to hear what you have to say about this as well, which goes into a lot more detail than I presently have time for.
posted by drywall at 9:29 PM on May 31, 2001

I think the idea that this will cause legitimate AIDS research to stop is insane. Sure, if it's given away free the drug company won't make as much profit, they might stop research, TEMPORARILY. However, drug companies are not the only ones funding AIDS research, and you cannot convince me that every single researcher in the world had profit as their only motive. Research will continue, breakthroughs will be made, and eventually, we will have a solution to the problem. With or without Brazil, with or without the big drug companies.

What's more, the drug companies KNOW that, and even if they are not in a position to make AS MUCH money, they will still play, because not as much is much better than none.

Downturns are followed by upturns, decreased research will be followed by increased research, these things self-correct. Less people look for a cure, more people get sick. More people get sick, more people look for a cure. Simple.
posted by Nothing at 12:14 AM on June 1, 2001

Most every large research university in this country is partially funded by mega corporations--don't get me wrong, this is good, insofar as research is being done in the very best and modern conditions. However the will of the mind, the will of the inquisitive student and the direction of her supportive professor are what drives the advent of the newer, better, safer treatments and drugs. No corporate laboratory is better than the education and the spirit of the persons who man it.

LJromanoff, you are gravely wrong, that "industry" is the panacea humankind has been clamoring for all these generations. Show me the scientist, who regardless of the money, wouldn't DO science even if there weren't money in it. And indeed, in most cases there is no money in the vast percentage of research that is done--interns, undergrads etc. Science itself is the impetus behind research. Ask the astronomer, marine biologist, exobiologist. Capitalism doesn't put curing elixirs into syringes, science does.
posted by crasspastor at 12:53 AM on June 1, 2001

More, much more, federally funded science education is what's needed. Thank you science guy. I mean guys.
posted by crasspastor at 1:12 AM on June 1, 2001

In re government takeover of the pharmaceutical industry. Do you REALLY want the same guys who have made a cesspool of social security, who advocate the bogus missile shield, who have done such a wodnerful job with public education, utility regulation and environmental advocacy, to be making and selling new drugs? Do you want to put your life in your congressman's hands, and hope that he acts in your best interest, simply because you vote?

Personally, I would place far more trust in a large company motivated by profit. A customer will always be better served than a constituent.
posted by UncleFes at 6:54 AM on June 1, 2001

There are other possibilities, beyond simply government-only research, or just private-industry under the patent system. For example, the government can buy out patents or offer rewards for product development. (From this Cato PDF, which additionally mentions a couple of disfuncationalities of the patent system, such as money/time/effort devoted to patent-workarounds.)
posted by claxton6 at 7:17 AM on June 1, 2001

Listen, if drug companies were interested in the public good, they'd be spending all of their time working on drugs for diseases like AIDS and syphilis. Instead we get stuff like Propecia and whatever that toenail-fungus drug was called.

I explicitly stated before that drug companies don't work for what you describe as "the public good," but instead for profit, which results in greater benefits for the public.

Are these drugs expressly for the very wealthy? Are upper-middle-class men the only ones who suffer from hair loss? No, but they're the only ones who have the dispoable income to bother paying for a drug to stop it.

Upper middle class? Rogaine is $0.50 a day for a three month supply. That's hardly out of the price range of almost anybody.

These drugs aren't developed out of a pressing public need.

No, they're developed out of a pressing public want. But ultimately all drugs are developed by industry to make money, which is fine, as it gets the drugs developed.

Microsoft does not make products that cater to the lower class or lower middle classs either. Check the stats: very few of those people have computers. They aim in the middle.

And they are huge because of it. My point was that companies do not gain huge wealth by only targeting the wealthy, as you earlier claimed.

You'd be a bad CEO if you didn't aim at the upper crust. In fact there's a lot of evidence to suggest that the only reason companies like GM make the smaller cars with the minimal profit margins is because the government forces them to, due to fuel mileage requirements.

No, they make those cars because it is profitable to make cars for those people who can afford them. The government makes them do it? Hardly. If GM wasn't making money from a vehicle it wouldn't produce it, period.

Do I want to nationalize food and clothing stores? Hmm... let me think, how much of the supermarket industry is driven by R&D that requires intellectual property law in order to be profitable?

Irrelevant. You claimed that it was the 'importance' of drug research that exempted it from the free market, and I pointed out that on the 'importance' scale that drugs aren't even close to the top.

Drug treatments aren't scalable.

And food is? Sure, there's cheaper beer and more expensive beer (for example), but there's hardly such a huge difference that one would have to be wealthy to afford the best. With some silly exceptions, the same is true for clothing.
posted by ljromanoff at 7:57 AM on June 1, 2001

LJromanoff, you are gravely wrong, that "industry" is the panacea humankind has been clamoring for all these generations.

I never said that it was, although take away everything that 'industry' has provided and we'd be a pretty miserable lot.

Show me the scientist, who regardless of the money, wouldn't DO science even if there weren't money in it.

It's not about WOULD, it's about COULD. Most scientists need significant financing - modern science is not cheap in most cases.

And indeed, in most cases there is no money in the vast percentage of research that is done--interns, undergrads etc.

Interns and undergrads are doing science for 'free' as you claim in order to earn something, either a job or a degree - it's hardly free. And interns and undergrads are part of wider science programs that have to be financed by somebody.

Capitalism doesn't put curing elixirs into syringes, science does.

True, but capitalism pays for the syringe, and the scientist's house, and the lab, and the computers, etc., etc.
posted by ljromanoff at 8:02 AM on June 1, 2001

Some historical perspective: Fifty years ago, the richest person in the world couldn't get their hands on, say, Paxil. Fifty years from now, every patented drug of today will be in the public domain.
posted by whuppy at 8:20 AM on June 1, 2001

The sick people of the US, Europe, and Japan subsidize drug development for the rest of the world. Discuss.
posted by whuppy at 8:25 AM on June 1, 2001

Drywall, you've set up a straw man argument, in naming Propecia (and by extention that kind of cosmetic product) as the benchmark. Propecia wasn't even in the top 200 drugs worldwide (it was 241st) by sales. The top ten? All products in cardiology/hypertension, depression, and allergy. And allergy (it's Claritin in the top 10) is only there because it is a prescription drug in the US but not in most other countries

AIDS is a huge problem. But heart disease and related conditions kills many more people than AIDS does and is a much more insidious problem. Depression is a huge quality of life issue. Is it really so bad that the drug companies top products are in these areas?

Further (and here I'll disclaim that I work in the industry), drug discovery is but a minor part of the whole mix. If the whole thing were as simple as finding new compounds the world would be a much better place, certainly. But there's a lot more to it than that - and marketing is a huge piece of that puzzle.

If you came up with a superpill that cured lots of things forever, it would still take years for it to be adopted by physicians. And most - probably 60% - of the total budget related to most products are related to that very issue - how to educate physicians about new products that can affect their practice and save lifes (or increase quality of life in the case of areas like oncology, rheumatoid arthritis, MS, and others). And that is a highly regulated endeavour (though not as highly, in the US, as I and many others think is appropriate).

Even before that happens, though, there are a ton of things related not to the molecule or compound itself but to the drug as a product that a company must do. It must study dosage, delivery mechanism, drug interactions, etc. It must follow thousands of patients for months and years for each dosage and for each indication for a product. It must further study the health economics factors related to any product so that it can make the case (or not) that a new product (in each indication) should be included in public and private formularies - so that patients themselves don't pay for it directly).

And then you have to teach doctors about it. If it's a hospital-administered product (usually administered by a specialist), it can take 3-5 years for a new product - even a revolutionary "blockbuster" drug - to start being prescribed at large by physicians in community hospitals. There's a well-established cascade of information through which this occurs, and it's startlingly expensive. It starts with the trials investigators (for a couple years pre-launch), then moves to "Key Opinion Leaders" in teaching hospitals. That takes a year at least, straddling the launch of a product. Then the cascade moves out to regional specialists in major hospitals, and finally to specialists at large in community hospitals. And rinse, lather, repeat for each new dosage (say, a one-a-day injection for Type-II diabetics rather than 2 or 3 a day) and indication (such as when ACE-inhibitors are found to be much more than simple hypertention drugs but fundamental in the entire treatment of Acute Coronary Syndrome.

That's all marketing - and none of it is "branding" related or DTC related. Some products have, in the US, tried to skirt this by front-loading a DTC strategy - the COX-2 inhibitors (Celebrex and Vioxx, from Pfizer and Merck respectively) are examples of this, used to treat rheumatoid arthritis. But even for these products, DTC didn't even account for a majority of the marketing budgets in the launch year.

As is common with me on this subject, this is a long post that might very well kill the discussion. But it's important. There are lots of people who wish to improve the workings of the pharma industry both inside and out. But we realize that can only be done by making reference to the reality of the situation, not by setting up straw men and knocking them down.
posted by mikel at 9:06 AM on June 1, 2001