week 11 - the pharmaceutical industry

the medical-industrial complex is comprised of what?

publicly traded multinational corporations involving pharmaceutical companies, health care personnel, and medical technology conglomerates

the medical-industrial complex involves the production and provision of a range of….

medical products, supplies, and services for profit

what is the leading influence in the medical-industrial complex’s expansion?

pharmaceuticals

pharmaceuticals’ influence on the medical-industrial complex is so powerful that it…

influences drug regulation policies in many countries

licit or illicit means what?

legal or illegal

drugs/medicine/pharmaceuticals can be…

legal or illegal

how are drugs determined to be legal or illegal?

by a socio-economic-political process

what makes a drug “good” or “bad” is shaped by what?

moral judgements

example of good/bad drugs being shaped by moral judgement:

opioids are legally used to manage pain but self-medicating with pot or lsd is viewed as not okay

what are the multiple purposes of drugs/medicine/pharmaceuticals?

treat, manage, and cure illness symptoms and conditions

why would drugs be used to alter psychic states and consciousness?

for self-actualization and recreational use

example of the religious and spiritual meanings and functions of drugs:

peyote and vision quests

what is a legal prescription drug?

any substance the government agency approves to treat a medical condition

who are legal drugs manufactured by?

pharmaceutical industries

why are legal drugs presumed to be safe?

because they are supposed to have met strict government standards

strict government standards for drugs are supposed to do what?

ensure drug efficacy, have peer-reviewed tests

despite protective measures, there are many drug scandals… which result in what?

addiction, iatrogenic disease, disability, death

for many drug and biomedical companies, what comes first?

profit

healthcare needs and safety of population are _____ to drug and biomedical companies

secondary

who are major players in canadian healthcare?

pharmaceutical industries

amount of money spent on drugs has been rapidly increasing. in 2021, how much did canadians spend on prescription drugs?

37 billion

of the 37 billion spend on prescription drugs by canadians in 2021, how much was spent on over the counter drugs?

6 billion

true or false: drugs are now the fastest growing category of health care spending in canada

true

does canada health act cover prescription drugs?

no

what is the one context where canada health act covers prescription drugs?

when they are administered at the hospital

canada is the only country with a single payer health care system ________ dental or drug coverage

without

prescription drugs make up ___% of all drug expenditures

83

what is the remaining 17% of drug expenditures?

OTC drugs

canadians stuck with increasing or decreasing drug costs?

increasing

< out of pocket expenses, drugs not covered by prescription, increased cost to employer sponsored drug plans, higher drug premiums, drug exclusions > are reasons for….

increasing drug costs

increase in drug expenditures is also due to aggressive drug ___________

advertising

who is the aggressive drug advertising to?

doctors, consumers

how are consumers advertised drugs?

via direct-to-consumer advertising

direct-to-consumer advertising is illegal in all but which 2 countries?

usa and new zealand

direct-to-conusmer drug advertising being legal means what can be shown?

the drug and its use

while direct-to-consumer drug advertising is illegal in canada, a loophole exists. so what do drug companies do?

advertise the drug but not mention its therapeutic use

drug companies continue to pressure governments to allow what?

direct-to-consumer advertising

true or false: CMAJ reported that health canada continues to fail to enforce bans on ads for prescription drugs

true

what are the 3 types of drug companies in canada?

foreign, domestic, small biotechs

what are foreign drug companies?

subsidiaries of foreign multinationals, manufacturers of brand name drugs

are brand name drugs more or less expensive?

more

what are domestic drug companies?

manufacturers of generic drugs

are generic drugs considerably cheaper?

yes

by how much are generic drugs considerably cheaper?

50 percent

3 conditions for when a drug can be manufactured as generic:

drug patent has expired or was not patented; patent is unenforceable, invalid, or would not be infringed upon; countries without drug patent protections

what is an example of something where a patent would be unenforceable or invalid?

wild or uncultivated plants in canada

small biotech drug companies focus on what?

early stage research

how much money do small biotech drug companies spend?

billions

what do small biotech drug companies use, and what do they manufacture?

use enzymes and bacteria to manufacture drugs and GMOs

is big pharma among most profitable manufacturers in canada?

yes

big pharma is __th largest and fastest growing manufacturing industry in canada

5

big pharma is __rd largest manufacturing industry worldwide

3

why does the use and profitability of drugs continue to increase? (thus making big parma so profitable)

because there is an increase in chronic illness conditions, increasing medicalization of life, aging population

big pharma is so profitable because there is a significant discrepancy between costs to manufacture a drug and what?

its selling price

production costs are much ____ than what a drug is sold for

less

why are drugs sold for a lot more than they are manufactured?

because of the lack of price competition due to the drug patent system

describe the relationship between health canada and the pharma industry

90% of funding for health canada to review safety and efficacy of drugs comes from the drug industry

new drugs are often about ______ rather than medical value

profits

of 271 new patented drugs in canada, less than 5% were what?

breakthrough meds or new discoveries that offered substantial improvements

of 271 new patented drugs in canada, more than 46% were what?

line extensions

when a new drug is invented, the company owns exclusive rights to manufacture and distribute it for how many years?

20

to stop generic drug versions from being developed and marketed after 20 years, what can companies do?

extend patent period by taking out additional patents or by slightly tweaking the chemistry of the drug to call it a different drug

big pharma is so profitable due to production and promotion of brand names over what?

generic products

generic name is the _________ name of the drug

scientific

generic equivalents are less costly than most brand names yet on script, doctors may write…

substitutions now allowed

generic equivalents are less costly than most brand names yet pharmacists may be instructed to…

not prescribe generic drug

in the us, doctors may have agreements with drug companies to do what?

promote their drug

what do doctors receive in return for promoting a drug company’s drug?

perks and kickbacks of a large sum of money

big pharma is so profitable because they do what with out of date drugs?

dump them in developing countries

dumping out of date drugs in developing countries allows drug companies to…

recoup costs for untested, ineffective or dangerous drugs, or drugs they had a surplus of

2018 WHO report found that 1 in 1- medical products sent to developing countries are either….

substandard or results falsified

why do some developing countries have such lax drug regulations?

because drugs are very much needed, expensive to produce or purchase, and they will take what they can get

why has a change in drug availably made big pharma so profitable?

because drugs once available only by prescription are now available as OTC or BTC

are costs of OTCs and BTCs covered by drug insurance plans?

no

trend to OTC and BTC drugs supported by ideologies of what?

self care and consumerism

big pharma is so profitable because there is selective info given to doctor and consumers about what?

efficacy and safety of drugs

20 years of research have shown that drug reps are selective about drug info provided to doctors… they transmit what kind of info?

inaccurate and/or only positive

do drug reps often mention side-effects and contraindications?

rarely

another negative effect associated with big pharma is that it is an outgrowth of what?

interlocking petrochemical industry

big pharma also produces…

pesticides, herbicides, and fertilizers

toxins from petrochemical industry products are responsible for many…

environmental health calamities like cancer and skin rashes

AstraZeneca produces an anti-cancer drug called tamoxifen but also produces petrochemicals linked to what?

breast cancer

describe the 1960 drug scandal regarding thalidomide

it was a drug for pregnancy-related morning sickness, and the mothers who took it had newborns born with abnormal limbs or no limbs at all

describe the 1938-1971 drug scandal regarding Diethylstilbestrol (DES)

it was a drug prescribed to prevent miscarriages and premature births, but it caused cervical and testicular cancer in children, as well as other reproductive abnormalities

the 1938-1971 drug scandal regarding Diethylstilbestrol (DES) had possible 3rd generation effects, meaning….

the grandchildren of the people who had taken the drug were affected

describe the 1960s-1990s drug scandal regarding HRT

it was a drug for menopausal women that was linked to breast cancer, stroke, and blood clots, especially if you smoked

describe the 2004 drug scandal regarding Vioxx - NSAID

it was an anti-inflammatory drug for arthritis that had results skewed to hide negative effects, and caused increased heart attacks

describe the 2010 drug scandal regarding oxycontin

the purdue family claimed this powerful opioid was less addictive, but knew that it wasn’t and that it would be abused, but they still concealed info and promoted it as safe

what is the correlation between the number of visits to the doctor and the number of prescriptions received by patients?

the more you go, the more prescriptions you receive

why do doctors prescribe drugs for 21-86% of their patients?

because many doctors prefer to do something rather than nothing, patients expect a script when they visit the doctor, its a reflection of the increased medicalization in society

important deficiencies in doctors’ knowledge means many rely on what?

commercial sources of information like ads provided by drug reps

important deficiencies in doctors’ knowledge significantly influenced what?

doctors prescribing habits

a 2000 ontario study found that the more often a drug is promoted, the more it is….pr

prescribed

what did doctors claim that was contrary to the finding that the more a drug is promoted, the more it is prescribed?

they claimed they didn’t let commercial sources influence them

many doctors are _________ of drug advertising

uncritical

range of __________ prescribing between 17-43%

inappropriate

___% of drugs are prescribed unnecessarily

18

30% of inappropriately prescribed drugs are related to problems in what?

drug admin, like dosage and duration of prescription

inappropriate prescribing by doctors is caused by their lack of what?

drug knowledge

even if doctors are aware of reliable sources for drug knowledge, they lack….

time to read and investigate in detail