America on Drugs

If you've been following The New York Times for the last few months, last week's story about psychiatrists and the payments they reap from pharmaceutical companies, while denying any influence on the kinds and amounts of drugs they prescribe, should come as no surprise. The ties between doctors and drug makers rightly raise important questions about conflict of interest in our current health care system. But it also points to how doctors, pharmaceutical companies, and American consumers have been swept up in the momentum of corporate capital and biomedical research that continuously holds out the euphoric promise of the next magic bullet, a cure for all our ills. How did we arrive at a point where health care revolves far more around curative drugs than public health initiatives aimed at the prevention of chronic disease? The recent history of allergy offers some clues.

Between 1972 and 1985, prescription drugs overall in the United States showed a modest seven percent increase in number of prescriptions filled. During the same period, prescriptions for asthma drugs increased 200 percent. The asthma market was booming. Allergists had by and large kept a healthy distance from the pharmaceutical industry in the immediate post-war era of drug development. In the 1980s, however, the relationship between physicians and drug companies shifted dramatically as both began to sniff not just pollen, but money, in allergy.

Marketing drugs and marketing allergy as a medical specialty became synonymous as disease, drugs, and doctors became more closely wedded than ever before. In 1985, Bruce Simpson, vice president of sales and marketing at Fisons Corporation, an important player in the allergy drug industry, alerted the American Academy of Allergy and Immunology to data that indicated a declining trend in patient visits to board-certified allergists. In a boardroom at the Logan International Airport Hilton, Simpson met with representatives from the American Academy of Allergy and Immunology, the American College of Allergy, and the American Association for Clinical Immunology and Allergy. Together they created an "Allergy Marketing Task Force" to educate the public and to sell the consumer and third-party payers on the value of the professional allergist and the drug industry in the treatment of allergic disease. For a contribution of $12,500 to the task force, a drug company would get a "gold card" that would grant its industry reps with privileged access to physicians. For $25,000, a drug company was guaranteed a place on the Allergy Marketing Task Force Board.

The Allergy Marketing Task Force Board hired a prominent public relations firm to launch a national media campaign during the spring 1986 allergy season. Television spots on allergy appeared on ABC World News Tonight and Good Morning America. Informational articles that highlighted the extent of allergies--affecting 35 to 40 million Americans--and the costs to the economy, estimated at $1 billion--blanketed national newspapers such as USA Today and more than 68 regional markets. Although many of these stories did a good job of educating the public about allergic disease, they also had a common refrain: loads of new prescription drugs had been developed within the past three or four years that gave most people relief from allergic symptoms.

As relationships between physicians and drug companies grew closer, and more financially intertwined, the American Academy of Allergy and Immunology (AAAI) found itself heavily lobbied from all sides of the pharmaceutical industry. Through its position statements, subcommittees, and representation on FDA advisory panels, the AAAI could greatly affect a drug company's earnings. Ethical drug companies that specialized in prescription drugs and cutting-edge therapies vied for influence over proprietary drug companies, which had traditionally catered to the over-the-counter and generic drug trade. Remaining above the fray of influence peddling by the drug industry posed a great challenge to medical societies like the AAAI.

In an era when clinical allergy became enmeshed in the world of billion-dollar drugs, no medical issue was free of economics and marketing. Any policy statement, or even the lack of one, could be taken by drug companies as a product endorsement. Drug companies rushed to cash in on the latest wave of medications that would promise allergy sufferers escape from the limitations of their illness. And American consumers have been lulled into complacency by symptomatic relief. Better drugs. Better profits. Better lives? Since the 1980s, mortality and morbidity rates from asthma in the United States have continued to climb. We can continue to fortify our bodies against an ever-changing environment with an ever-changing barrage of drugs, or we can begin to address issues of land use, rethink building construction, and confront structural inequities in housing and health care in American society that have structured the experience and rise of allergy in America. The choice is ours.