Customer Reviews

Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies

5 star:		(3)
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3 star:		(1)
2 star:		(3)
1 star:		(0)

 

 

Clearly, this is a book worthy of the acclaim the author recieved for his previous work. In this critical account(well-researched, but starting with a very biased opinion to begin with) Crister takes a look at how "Big Pharma" has evolved and changed everyone's lives. The early parts of the book focusses on the evolution of the trade group associated with the drug companies, their motivation and objectives, the personalities involved in its growth, and the inter-play with the politicians and regulatory agencies. Much of that discussion is based on the patent laws and their impacts on the drug companies and the patients.

Essentially, the author states a bold premise at the outset of the book - the prescription medication habits of patients is centered around "polymedication" (using multiple medicines to treat the same condition) and overmedication and that it is the fault of the drug companies for creating that scenario. While the observations in the book are perhaps accurate and convincing, it certainly does provide a skewed picture of the operations of the drug companies (no one can dispute the fact that they are for-profit companies trying to increase shareholder value).

Whether you agree with the author's premise or not, the book systematically explains his rationale for his premise, interspersed with some interesting anecdotes regarding advertising, direct-to-consumer marketing, politics, and personalities.

A good (albiet, slightly biased) look at the operations of Big Pharma. At the very least, one can gather excellent information on the politics and marketing mechanisms of Big Pharma and their interactions with the regulatory agencies. A must read for anyone who is a patient (or "consumer" of drug companies!) or an investor in Big Pharma.

Like many other American's I have taken perscription medicines. Often I have wondered why I am getting the script for the latest drug I have seen on TV when I know other, cheaper drugs have worked in the past. This book really delves into the way drug companies market themselves to the physicians, and then how and why they started marketing to consumers.
I don't know how many of you have sat in doctor's offices waiting for your appointments and have been frustrated when drug company representatives come in to visit the doctor while you wait. Perhaps this has happened to you. I have been amazed as to why going in for something simple you can walk out with several perscriptions. Greg Critser suggests that it is through marketing and giving incentives to physicians this happens. As physicians write more and more perscriptions they are gifted by the drug companies. Once they realized how great that marketing technique worked, we started to see ads directed at consumers.
In their marketing, they have often suggested that some drugs work on symptions that the drug did not intend to treat initially; for example, Paxil for shyness, Prozac for PMS. Doctors can legally perscribe a drug for any reason they want to. Meaning marketing in this way, the drug isn't tested properly, and is being given to patients to test out the drug. In recent years we have had problems is Phen-Phen, and Viaox.
This book is heavily slanted against the drug companies. The book does cast them as a villian, no doubt. What I liked was that it made you think. Perhaps with some knowledge of how the drug business works, a consumer can go in and ask if the drug was specifically developed for what the intent of treatment is. You might even want to learn to ask about alternative and less expensive treatment. It was good, but very biased read.

Here, as in his FAT LAND, Critser performs a public service in the best possible format. Major issues like the growth of the drug culture are usually presented with more technical detail than the non-specialist can stand or with lurid alarmism. Here Critser condenses huge amounts of data and first hand research in a prose that is both lucid and interesting. In a country where every other ad is for a drug, each citizen should read this exciting volume.

Greg Crister, in his new book, Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies, puts forth the notion that "big pharma" has created a nation of pharmaceutical tribes, each with its own unique beliefs, taboos, and brand loyalties. According to Crister, there are 3 such tribes:

1. Tribe of High-Performance Youth: children and adolescents who are medicated for depression, attention deficit disorder, and a range of other psychological and behavioral problems mostly because of "their parents' completely under-standable wish that they perform well in a society of ever increasing demands to perform well, nay, superbly."

2. Tribe of Productivity and Comfort (MiddleYears): those of us at the middle-to-late points in our careers as parents and/or earners who are preprogrammed to consume drugs like Lipitor, Viagra, Prozac, and Prilosec, to "shore up our ability to produce more and better and to relieve discomfit, including the discomfit of having to watch what and how much we eat and drink and of sitting on our duff."

3. Tribe of High-Performance Aging: seniors who take drugs "not only to alleviate the discomfit of aging, but also to extend their lives."

Crister credits Pat Kelly, president of U.S. Pharmaceuticals for Pfizer, for inspiring the idea of consumer tribalism-pharma's need to sell lifestyle, not things. "By conjuring brand tribalism-an intense, interactive, and information-driven promotion of a product and the values it is made to seem to embody-a company can not only gain new customers, but also hold on to the old ones," says Crister.

According to Crister, before big pharmaceutical companies could create these tribes to consume their drugs, they had to become "unbound" from government restrictions. Crister devotes about 100 pages-38% of the book-to a history of how direct-to-consumer (DTC) advertising became legal is the U.S.

I found this to be the most interesting part of the book because of the first-hand accounts of people who played critical roles in making DTC advertising possible. Some of these "DTC pioneers" are still part of the pharmaceutical advertising scene today. Also, I know some of these people personally, which makes reading the story all the more interesting. Crister's account-which I have no reason to believe is inaccurate (the book is chuck full of references)-gave me insight into the backgrounds of these pioneers and how they got to where they are today.

Crister seems to have had unusual access to the principals-including pharmaceutical executives-involved. He peppers his story with many quotes and colorful phrases based on these interviews. Although I am happy that these people's stories have been told in their own words, some of these words have been used to make Crister's case against the industry.

There are a few juicy anti-DTC quotes from pharma execs in the book. Although the execs made these statements prior to DTC becoming legals, twenty-five years later and with eight years of DTC experience, the industry is still confronted by critics regarding DTC's cost, educational effectiveness, and ability to present risk information. For a review of these issues, see my article, "DTC Pros and Cons Presented at FDA Hearing," in Pharma Marketing News (www.pharmamarketingnews.com).

Crister, of course, has an axe to grind with the pharmaceutical industry and offers up the same criticisms of pharma marketing practices as did many other critics before him. His distinction, however, is the colorful and amusing language he uses. Here's a sampling in no particular logical order:

* On blockbuster drugs: "By late 2004, blockbusterism, the jumbo golden Rx goose, seemed to have laid its last egg."
* On CME: "The Demi Moore of this lap dance is CME."
* On Gen-X marketing: "The synergy marketers boogied at full tilt." I am still not sure what he means by that.
* On the liver: "the canary in the mineshaft of Generation Rx."
* On patients as consumers: "a person with medical needs" these days acts "as if he is not going to the doctor but rather to the mall." Crister's main reform idea is that patients should stop thinking of themselves as consumers and that we all should cut down our own use of prescription drugs. Not a bad suggestion, but utter radicalism to some pharmaceutical marketers.
* On the Pharmaceutical Marketing Congress: "the world's fair of pharmaceutical marketing."
* On Pat Kelly, president of U.S. Pharmaceuticals for Pfizer: "unquestionably, the definitive lead guitar player in the rocking world of modern drug marketing."
* On physician detailing: "more of a pharmaceutical lap dance than, like, and old-fashioned sales call." For more on the relation of sex and sales reps, see Pharma Marketing Blog ("Sexy Reps Sell Rx"; www.pharmamarketingblog.com).
* On polypharmacy: "in that regard most drug companies have been as responsible as a thirsty sailor in port after a year at sea." He said "thirsty," but I am sure he meant "horny."

Aside from the seminal events described above, Crister also recounts the history of many other "firsts" in DTC, including the first DTC ad that mentioned a drug by name and, afterward, the first non-branded, help-seeking ad that was designed to "drive patients to their doctors." I'll leave it up to you to read the book if you want to learn more about these events.

I will also leave it up to you to read the book for Crister's solutions, which appear to be the usual ones suggested by other critics. Crister does suggest something unique: get a healthy life in order to "pharmaproof" yourself.

GenerationRx is extremely informative and a fine introduction to the manner in which prescription drugs have moved to the fore through media advertising. Chapters seem endless but persistence is well worth the effort. The second half of the book becomes increasingly practical. The concluding advice and the listed web sites are well worth the investment.

Everyone should read this book. It opens your eyes to what goes on behind the scenes of the pharmaceutical industry and the aspects of direct to consumer advertising of medications. This will encourage people to question their doctors and force them to use their knowledge instead of following the bribes drug reps give them. This book also teaches us to trust our pharmacists and make use of their offer to counsel. This book could change the health care industry for the better.

If nothing else, this book will make you think twice before filling that latest prescription from your doctor or the multitudes of drugs we are already putting in our bodies. Of cousre, this book is biased against Big Pharma but isn't that sort of to be expected? After all, they have had a part in how we perceived prescriptions and how/if we comply we comply when our physicians load us up with prescriptions. I'm not saying I agree with everything in the book- because I certainly don't, but I think it is a good read and it is though provoking.

What Greg Critser offers in this book is a wide-ranging critique on the excessive use of pharmaceuticals and how we got to the point we are currently at.

Among the things that I gleaned from "Generation Rx":

A clear description of what "off-label promotion" is.
The connection of conservative think-tanks to the pharmaceutical and advertising industries.
Prescriber profiling.
DTC-Direct To Consumer advertising.
"Research Surfing".
The rush to FDA approval motivated by quicker profits.

Mr. Critser also details some of the many horror stories of side-effects from various prescription medications. Some of the organs involved like the liver and heart.

The author also observed the gradual change from a physician-patient relationship to a more complex relationship where physicians are pressured to prescribe meds for ailments that the drug wasn't approved for. The patient also became a consumer by way of DTC advertising.

On the political front, Mr. Critser detailed the blackballing of an FDA commissioner candidate by pharma purely based on protecting their profits and ideology.

Among the solutions offered by the author were-
Transparency by physicians-disclose connections to pharma.
Regulation by a rejuvenated,empowered FDA.
Separating pharma power from individual health decision.

I found the book to be an interesting read about a topic that has been a hot issue for some time. It's suited for the laymen that has an interest in the subject.

Generation Rx" begins by musing over an article in the House and Home section of the New York Times reporting the rise in popularity of "triple-wide" medicine cabinets - taller, wider, and deeper. Cause of this phenomena - the average number of prescriptions/person was 7/year in '93, 11 in '00, and 12 in '04 - despite enormous uncertainty about their benefits and safety. (There are an estimated 106,000 deaths/year from serious adverse drug reactions from just those properly diagnosed and taken. Drug-induced liver disease is the most common cause of acute liver failure - more than viral hepatitis.)

A major source of this growth is the increased amount spent to advertise prescription drugs to consumer - from $2 million in '80 to $4.4 billion in '04. Protecting these investments and sales is an additional one-half billion/year spent lobbying by pharmaceutical firms.

So much for the interesting part. The vast bulk of "Generation Rx" is a rambling series of anecdotes guaranteed to put the reader to sleep. I instead would recommend "The Truth About Drug Companies," and "Overdosed America" - both written by eminent physicians.

I give Mr. Critser credit for his writing ability as well as his ability to make and sustain an argument. The book flows like crazy. But that's also where the book breaks down for me. It is a long argument, rather than a painstaking work of investigation. I kept thinking that the author went into this with an axe to grind or some other kind of vendetta, and this book was the result. I also felt at times that he was trying to sensationalize his points, i.e. draw a more inflammatory conclusion than was warranted from the evidence he had at his disposal.

Some people may consider it worth reading simply because it's so well written; this will be especially true for the growing numbers of Americans who share Mr. Critser's cynical perspectives on the drug industry. No doubt they'll root him along as he moves from chapter to chapter. For me, I can't justify more than the two stars I've given it.