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Peter Rost, M.D., is a former Pfizer Marketing Vice President providing services as a medical device and drug expert witness and pharmaceutical marketing expert. Judge Sanders: "The court agrees with defendants' view that Dr. Rost is a very adept and seasoned expert witness." He is also the author of Emergency Surgery, The Whistleblower and Killer Drug. You can reach him on rostpeter (insert symbol) Please read the terms of use agreement and privacy policy for this blog carefully.

A Book Review by Friendly Curmudgeon

Review of Peter Rost's Whistleblower, Big Pharma, and middle aged doctors and new careers

Ok so here is another book that soundly condemns the industry that I sort of work for, in that I am a medical editor in an agency that provides physician and patient online (mainly) educational materials about drugs and devices and the diseases they treat. Almost all of the work I have done in this company has been funded by Big Pharma.

Is it a good book? Does it tell a compelling story? Yes and yes. It turns out Dr Peter Rost was an executive with Wyeth then Pharmacia/Pfizer and tried with all 3 companies to point out certain illegal or unethical practices, that is he was a classic whistleblower. With Wyeth he pointed out some tax dodging and was promptly demoted. With Pharmacia which was taken over by Pfizer he started by pointing out some illegal marketing tactics with a growth hormone that occured before he started in that area. When Pfizer ignored his complaints also he then pointed out some other issues. He finally ended up being fired, and is still pursuing legal recourse. At the time Pfizer took over he was being paid quite well to manage the endocrine division and was doing a great job selling the drug legally. He also dared to speak out as a private citizen about high drug prices in the US and the potential for saving dollars with reimportation, a process that has kept prices down in Europe for years.

The big issue for me is that this book tweaked my conscience, leading me to ask myself once again whether working in pharmaceutical marketing was such a good thing to do. As with the book Overdosed America by Dr John Abramson and others by prominent doctors, the evidence is out there that Big Pharma is an evil industry. Charging the highest prices in the world to US patients, lobbying for a Medicare drug act that does not allow for negotiation of drug prices, hiding negative trial results, covering up illegal off-label marketing, ignoring side effects, etc etc. The high prices are always said to be justified given the high cost of new drug development and the need to have a profit to ensure ongoing capitalization, that is bolster stock prices. Dr Rost notes in his book that one pharma comapany as an example had revenue in 2003 of $22.5 billion but spent $3.2 bilion on drug research and development and $6.4 on marketing, sales and administrative costs. Paying out dividends of $3.3 billion they still recorded a profit of $6.8 billion!! So if prices were brought down by price controls, reimportation or a mix of approaches, then something would have to go, maybe profit? The highest profits in all industries are in big pharma. Maybe, sales and marketing? Part of that cost is free drug samples. If drugs were affordable or covered by universal health care, maybe free samples would not be necessary. Surely there is still plenty of wiggle room to ensure good money spent on R&D.

Then there is the issue of the corruption in the industry. All of the illegal activities leading to whopping fines, in the hundreds of millions but still often only a fraction of the multibillion dollar income generated by the blockbuster drugs. Rost nicely summarizes this, and adds that this sickens him, because he actually likes working in the industry, something that he will never do again after the Pfizer firing. We do have to remember that many of today's drugs save lives, improve quality of life, reduce pain and suffering. So we need these drugs, it just would be better if they were cheaper, safer, etc. The one thing I wish Rost had added in his book if available would have been a comparison of big pharma to other industries like big oil, defense industry (Halliburton anyone?), industries with companies like Enron, World Com even Walmart who have again and again been chastiaed, fined and worse.

If the pharmaceutical industry is no worse than others in avoiding taxes, cheating with marketing practices etc, then the main issue is price and safety. Controlling prices and beefing up the FDA may help to alleviate these problems. But we have a long way to go, baby!

In thinking about my own second career in pharma marketing, after practicing medicine for over 20 years, I have to once again, on the basis of Rost's book ask myself am I in the right place? My scheme to reduce drug prices by reducing marketinng would be like shooting myself in the foot. I have personal reasons for not returning to the practice of medicine so that would not be an option. I am too young to retire either. So once again I have to hold on to what is good in big pharma and keep on keeping on...

As for Dr Rost and his future? Well Peter, I am going to send you a link to this post so you can see my review but also so I can give you some ideas. We are both middle aged physicians although I am 10 years older and neither of us can easily return to clinical medicine. I am going to stick with what I am doing for now, but you, heck, you have so much pharma experience and youthful fervor. Since working for Pharma is out why not work for the FDA, I know would be a great decrease in income but you would be on the right side of the Force for once. Another possibility would be to work for Dr Sidney Wolfe or set up a similar business to his Health Research Group and Worst Pills, Best Pills. And here is another even wackier idea, start your own pharma company, if you can somehow get the financing, perhaps you could devote half your R&D to developing drugs for the poor developing nations and get some start up money from Gates/Buffett venture?

Just my musings forced on me by reading this fantastic book which I was lucky to get on Amazon on its first day of sales when it sold out its entire first printing! See Amazon on the book here.

posted by Friendly Curmudgeon


Blogger MsMelody said...

Dear Curmudgeon—

Thanks for the review . . .and your closing graphs were intriguing. In Too Profitable to Cure, the author addressed the “non-progress, non-improvement” in the treatment of diabetes over the past 2-plus decades. Many long-time diabetics, who have used both natural and rDNA genetically-engineered insulins, have long hoped for a white knight to re-enter the U.S. marketplace to provide needed insulins. No R&D required!

Unfortunately, even Dr. Rost’s marketing skills would be tested should he try to dispel the lies and half-truths that have been used by Lilly and Novo over the years to “enhance” rDNA insulin and vilify natural insulins. Though they have no proof that rDNA is “better,” Eli Lilly and Novo Nordisk have honed their marketing skills and convinced older doctors—as well as an entire new generation of doctors, pharmacists and other healthcare providers--that animal insulin is “dirty,” has a risk of BSE contamination, is subject to scarcity of animal pancreatic tissue, etc. If doctors were now to re-endorse natural animal insulins they, like you, would be shooting themselves in the foot by admitting complicity in supporting/enabling the present insulin cartel.

In the late 60’s a diabetic could walk into any pharmacy and, without a prescription, purchase a vial of insulin for about $10. He could choose from 3 species (beef, pork & beef/pork) as well as a host of formulations with different pharmacokinetics. Today not only are prescriptions required, all that remains are a very few rDNA formulations. As “new and better” (meaning just-patented) hits the market, the insulin cartel removes their former “latest and greatest.” Costs are increasing ($45-$100 per vial) and because of the dangers inherent in the newer formulations, a host of CYA technology is required to “assist the diabetic in his treatment protocol” while providing deniability about the very dangerous nature of insulin.

Third world countries could most certainly benefit from the safer animal insulins. Because they (diabetics in poor countries) cannot afford monitors, they will be particularly at risk when all that remains for their treatment are the unpredictable, labile rDNA products. These people often cannot even afford food on a regular, predictable basis. To try and match food and problematic insulins in such an environment is a recipe for disaster.

Shoot, maybe you and Dr. Rost could enlist Warren and Bill to help you establish a natural insulin manufacturing plant in a Third World country . . . and we could IMPORT from them. THAT would be a true win-win situation. Still, Dr. Rost would have to perform one hell of a marketing miracle. Good idea, but probably too much work and too little profit.


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