A Call to Action: Taking Back Healthcare for Future Generations, Hank McKinnell, McGraw Mill, 217pp. $36.95 Reviewer: Arthur Schafer Hank McKinnell gives the impression of being a thoroughly decent man. He is a devoted husband and father and, in his role as Chairman and CEO of Pfizer Inc. he comes across as idealistic and charmingly folksy. McKinnell cares about his employees and cares about the health of Americans. If we take him at his word, he aspires to provide moral leadership to Pfizer so that it will be widely perceived as a truly soulful corporation. Pfizer is the wealthiest and most powerful drug company in the world, which is, understandably, a source of pride to its boss. But the company has, at the same time, achieved notoriety for some of its unscrupulous research practices, not to mention its dubious marketing of drugs which it knew, or should have known, to be useless and/or dangerous to patients. Extravagantly high prices for some of its blockbuster drugs have also led to a degree of public opprobrium. Occasionally, in this book, McKinnell acknowledges that Pfizer could have done a better job; but, for the most part, he attempts to defend the company against its critics. His tone is reasonable and measured, but his defence is superficial and unpersuasive. Let’s consider a few of the charges brought against Pfizer by critics. First, the company is charged with publishing biased research in order to exaggerate the benefits and downplay the harms of its new drugs. One of Pfizer’s biggest money-spinners, for example, was the anti-arthritis drug, Celebrex. Almost overnight, with the benefit of massive direct-to-consumer advertising, Celebrex became the goose that laid billion dollar golden eggs for its owners [first, Pharmacia and then Pfizer]. In 2003, US physicians wrote more than 20 million prescriptions for Celebrex. But its fame and fortune were based on a clinical trial in which half of the data were suppressed. When data from the entire trial were finally made public, there was no advantage to Celebrex. Later, it was discovered that the Celebrex, like Merck’s Vioxx, doubled or trebled the risks of heart attacks and strokes. Company scientists were aware of these risk factors before a single pill was sold, but for years they failed to alert either the medical community or the public. None of this is discussed in McKinnell’s paean to Pfizer’s devotion to research in the public interest. Just a few weeks ago, in the USA, a Minnesota Federal Judge excoriated Pfizer for failing to warn patient’s that its antidepressant, Zoloft, posed a serious suicide risk. Pfizer now admits that it knew of the elevated risk. Shamefully, the company argued in court that it should not be held liable for non-disclosure of risks since it had complied with the FDA’s minimal standards. This defence didn’t wash with the judge, and it won’t wash with patients and their families. Viagra, like Celebrex and Zoloft, is another huge money-spinner for Pfizer. McKinnell is proud of the benefits Viagra brings to “men who had given up hope”. Even Pfizer’s critics have to concede that for men who are diabetic or who suffer from spinal cord damage, Viagra often works to cure their “erectile dysfunction” [ED]. The critics point out, however, that Pfizer is able to make huge profits from Viagra only because its advertising has persuaded millions of healthy men that they “need” Viagra to enhance their sex lives. I engaged recently in a television debate with a doctor who parroted the company’s propaganda that ED is a problem in 52% of men aged 40 to 70. In North America, that would yield the startling total of 33 million men who potentially “need” to take Pfizer’s drug. [The doctor did not disclose to viewers that he was a paid consultant to the drug industry.] However, scientifically reliable studies in Holland and Japan indicate that men in those countries, even the elderly, don’t suffer from the epidemic of ED that Pfizer claims prevails among young men in America. One doesn’t have to be a cynic to suspect that the so-called ED epidemic is a marketing ploy, intended to turn healthy men into consumers of a drug they don’t need. For most of the men who are buying Viagra, it is a “lifestyle” choice. They are seeking longer-lasting and harder erections. When some of them later go blind, a known side effect (though not a common one), they may wonder whether it was the right choice. As for how well Viagra works, well, the company’s web site claims that the drug’s success rate is an impressive 80%. This figure is much higher, however, than would be justified by most of the scientific studies; moreover, if one examines Pfizer’s definition of “success” you’ll see that their criterion is “improved erections” rather than successful intercourse. Alas, an awful lot of Viagra consumers are in for a let-down. In the first two years after Viagra was introduced to the medical marketplace, Pfizer spent $303 million [US] on an advertising campaign to promote public awareness of erectile dysfunction. “Ask your doctor”. McKinnell is a big fan of direct-to-consumer advertising, but Pfizer’s promotion of both Celebrex and Viagra demonstrates that companies with their eye on the proverbial “bottom line” are not entirely reliable “educators” of the public. Pfizer also pays fortunes of money to prominent doctors to encourage prescription of their drugs. These key opinion leaders [KOLs] work for the company as freelance consultants. Their role is to persuade both their medical colleagues and the public that we should be consuming more of the company’s products. A worrying conflict of interest, but one which does not worry McKinnel. For those who seek objective information about the drug industry and its modus operandi I would recommend that you give this book a pass. Instead, pick up a copy of The Truth About the Drug Companies, by Marcia Angell. It’s the real thing. Arthur Schafer is Director of the Centre for Professional and Applied Ethics at the University of Manitoba. He advocates cycling and a vegetarian diet as an alternative to drug consumption.



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