How women should think about their role in a society where prescriptions are everywhere.

Question: What are the most pressing health issues for women in the developed world? 

Judy Norsigian: Well in industrialized countries there is no question that the encroachment of the pharmaceutical industry and its marketing practices has deleteriously affected the kind of medical care we get and the decisions that consumers are making. Many countries don’t allow something we call DTC or direct to consumer advertising. The United States does and what has happened is that the pharmaceutical industry can directly market its products to consumers. 

Until late 1990s the pharmaceutical industry could only market prescription drugs to healthcare workers, to physicians and then there was a relaxing of those rules and they could market their product directly to consumers creating this clamor for the latest brand name product, which might not even necessarily be better or safer than the existing product on the market. 

What we see too is that because R&D is so expensive there are a whole bunch of me too drugs and that the pharmaceutical industry is largely engaged in producing drugs that will come on the market to deal with the fact that something is off patent. It’s going to be cheap because it will be generic, so we need something new and different. Maybe minisculely different from a previous drug and I think the story of Prilosec and Nexium is probably one of the best stories you can tell about a product that comes on the market really not any markedly different from the first product, but that can be sold at ten times the cost of the first product, sometimes more. Then you’ve got the issue of whether or not you control pharmaceutical pricing. That is a huge problem in terms of access to medicines that we do need access to and in many countries there are government controls over pharmaceutical pricing, but in the United States the drug industry’s lobby has been so powerful that we don’t see those same controls over drug company pricing. We’ve had some efforts. The VA Administration of course is one place where we’re able to see some measure of control over the pricing of drugs and the VA system actually is one of the best systems that functions in our country today. 

Question: How can women decipher the drug information they're getting? 

Judy Norsigian: All of our materials emphasize for women the fact that commercial interests are producing much of the written material, the electronic material, the TV shows that they see now, that they can’t assume that they’re getting unbiased, uncompromised information, that conflicts of interest exist everywhere. So we say learn the source of your information. Is it a drug company producing the material? Sometimes it’s actually not bad information, but very often it is all about minimizing the harms, the risks and maximizing the benefits and exaggerating the benefits, so you have to look deeper beyond the sort of 20 second bullet points you see. Even physicians are inappropriately influenced by pharmaceutical advertising and educational programming, so you can’t always depend on your physician. One excellent example is the overuse of statin drugs in women for primary prevention of heart attacks, things like that that for secondary prevention we have very good studies that show benefit for women, but not for primary prevention, so now women who simply have an elevated cholesterol level, no other problems are told to go on statin drugs when in fact in many cases they stand to be hurt more than helped. Getting at the kind of data that evidence based folks have produced, those without conflicts of interest, these are physicians and researchers whom we try to work closely with, getting at that information is often hard because it doesn’t make it onto television. It is certainly in the medical literature, but there is no PR company getting that out to you, the public, so we are a voice for those sources of uncompromised information. We make sure it is in lay language and we get it out at our website, through our blog. We have a very popular blog, Our Bodies, Our Blog that many women read every day and we send our readers and our listeners to these other sources of more dependable information where there aren’t conflicts of interest and that is something every single woman has to think about and be concerned about is where is the conflict of interest here, am I getting information that is truly not tainted by commercial interest. 

Another excellent example of where we saw this was in the recent new mammography guidelines produced by the US Preventive Services Taskforce. These are excellent guidelines. Those who have a lot to lose if women under 50 don’t get routine mammograms or if women over 50 do it maybe a little less frequently based upon their profile they have a lot to lose. Those are the ones critiquing this, not the evidence based folks. Those without conflicts of interest and there are many of them out there, have reviewed what the Preventive Services Taskforce has produced and certainly our experts, those for the National Women’s Health Network and several other wonderful organizations have to bat and said, “These are excellent guidelines.” “We should be following them.” It’s not about denying women care. And by the way, everyone should understand that mammography is a relatively weak tool for screening. We need better tools in the area of breast cancer. It’s not like pap tests where we have an excellent screening tool for cervical cancer. We’re not doing so well in the area of breast cancer, so there is an area where you would have seen the American Cancer Society. You would have seen some prominent folks in breast cancer treatment and people who have interests, in some cases in the equipment, the mammography equipment that is being sold. They have financial interest in it, so of course they don’t want to see the business go down. These are things the public doesn’t see very easily.