Stefan Ecks- Global Pharmaceutical Markets and Corporate Citizenship: The Case of Novartis’ Anti-cancer Drug Glivec
Glivec is a drug used to treat Chronic Myeloid Leukaemia and Gastrointestinal Stromal Tumours (GIST). This drug stalls the progress of cancer, and needs to be taken consistently through out one’s life. In 1972 Indian patent laws strictly protected the process of drug manufacturing, however did not concern the drug’s active ingredients. Thus ingredients could be reverse-engineered, and drugs could be generically produced. This resulted in thousands of drug companies competing with each other, bringing down the prices of drugs in India.
In 2003, Novartis was given the Exclusive Marketing Rights for Glivec. Before that, nine Indian pharmaceutical companies sold the drug for 90 percent cheaper than Novartis. However, in January 2006, Novartis was denied an Indian patent for Glivec and thus decided to take legal action, with the goal of becoming the sole manufacturer of Glivec and its ingredients. The Chennai Patent Office disallowed Novartis’ demands under Section 3(d) of the Indian Patents Act of 2005. This section asserts that “variations of known molecules will be treated as ‘the same substance, unless they differ significantly in properties with regard to efficacy”. This clause ensured that companies would not try to refresh their patent claims by making small variations to the molecules of an already existing drug. The Indian Patent Office found that in this case there were no significant changes made by Novartis that made Glivec more effective then what was already patented. After much appeal and deliberation the Indian courts tossed out an additional lawsuit from Novartis, because it was established that the state has ‘constitutional obligations to provide good health care’.
The case of Novartis vs. the Indian government had great implications in the field of pharmaceutical drugs, and more generally the field of medicine. If the Novartis lawsuit succeeded and section 3(d) was eliminated, the consequences would be catastrophic. Global drug prices would increase dramatically in the 3rd world, due to the heavy reliance these countries have on India’s exports of cheap generic drugs. If large drug companies like Novartis and Fizer are able to establish a product patent regime, then generic competition is limited and patent-holding companies can exploit their monopoly to establish high prices. The tightening of Patent laws drastically decreases the availability and affordability of any drug, making it inaccessible for those in lower social classes. Novartis is thus arguably killing innocent people, instead of giving lifesaving drugs to those who need them; this company was taking them away for capitalist profit maximization.
Novartis then attempted to change its public identity to one of the world’s more ethical and respectable companies. In 2006, Novartis gave away $755 million dollars worth of medicine to fight leukaemia through the Glivec International Patient Assistance Program (GIPAP). Ecks posits in this article that Novartis gave drugs to 33 million patients worldwide in order to build up a large contingency of pro-corporate citizens who feel indebt to the company. Also pointing out that the motives behind Novartis’ gift giving were that which concerned profitability rather than humanity. Ecks claims that Novartis gifted its product in some 3rd world countries in order to control its monopoly over the drug market in the world’s developed countries. Anticipating a price drop, if developed countries were to be made aware of how cheep Glivec was sold in developing markets, the company decided to gift Glivec strategically. This option not only maintains high Glivec prices in Novartis’ primary markets, it also depicts a good image of the company. Eck purports that by labeling economic interest as interest-free gifts, Novartis successfully masked and accommodated their purely capitalistic intentions.
Kalman Applbaum: Getting to Yes: Power and the Creation of a Psychopharmaceutical Blockbuster
Applbaum initiates his thought by looking at the Distributive Channel concerning pharmaceutical drugs. The meditators who compose this channel range from physicians, regulators, pharmacists, and hospitals to family members and social contingencies. All these separate dynamics together form the existing paradigm in which the pharmaceutical drug exists. Drug Companies must then align their interests with these competing members of the Distributive Channel. Applbaum claims that pharmaceutical marketers must hence look at their task as a social process that shapes and defines the public perception of a particular drug.
Drug companies have alternative means to which they can penetrate the market. Applbaum uses Prozac as an example of how physicians can be used as a tool to prescribe more drugs. Family Physicians are often re-educated with expert opinions and scientific information in a manner that increases their drug prescription habits, as opposed to psychiatric referrals. Corporations can also benefit from lax FDA regulations that give more leeway to drug companies to operate more freely. These are two examples of how Applbaum’s Distributive Channel can be used as a tool to create the market for a certain drug.
Applbaum uses Eli Lilly as an example of a company that through the Distribution Channel expanded their market. This drug company claimed to have discovered new applications for Zyprexa. With this claim Bipolar Disorder was in a sense redefined and expanded to attribute milder or more intense versions of the disease. This claim ultimately expanded the disease criteria to Bipolar Disorder 1 and Bipolar 2, and also Cyclothamia (milder version of Bipolar Disorder) all of which could be treated with Zyprexa. Eli Lilly was able to use DTC effectively to create confusion amongst the public regarding the legitimate definition for Bipolar Disorder. In this case DTC advertising aligns itself within the Distributive Channel to create and expand the market. Furthermore, by having their information expressed by sources that are external to the company, they are able to hide the drug’s commercial interest. Hence, by indirectly influencing the social awareness for a drug and its culture, drug marketers can effectively expand their product market.
Applbaum concludes by stressing how strategic marketing can set the medical playing field entirely. Controlling both pro and apposing sides, intermediaries have no power over the role they play in advancing corporate interest. By controlling the socio-cultural process that produces, defines, and prescribes information on a drug, they gain ultimate power to manipulate prospect patients as they please.
Joseph Dumit:Pharmaceutical Witnessing: Drugs for Life an Era of Direct-to-consumer Advertising
Dumit posits that with the use of Direct-to-consumer advertising Pharmaceutical interests have changed the culture of illness in the field of medicine. This marketing method has successfully altered the grammar of illness, risk, experience and treatment. Patients no longer view health as being free from illness or as Dumit puts it “the silence of the organs”, but rather a new conception is emerging which understands the body to be inherently disordered. This risk reducing conception thus subsequently renders a life on drugs as natural and imperative. In the following passage Dumit maps out a five-step marketing strategy routinely utilized by pharmaceutical drug companies in order to approach individuals who are unaware of the need for a particular drug in their life.
Step 1- Awareness Through Education
Dumit claims that the initial step for Pharmaceutical marketers is to expose the public as being completely ignorant to a particular disease. The publication of possible disease risks is usually accompanied by a sense of urgency to treat them early and aggressively. Also, portraying the health-aware individual as one who acts in accordance to medical facts, and the opposite as people who are confused, ignorant or embarrassed. These prelaunch promotion strategies attempt to prepare potential customers for future product use, and at times this is done blatantly with similar color schemes and typography, which is intended to associate the possible disease to the corresponding pharmaceutical drug.
Step 2- Personalizing the Risk
Once a potential customer becomes aware of a risk through DTC advertisements, and accepts that it is possible, they must be made to personalize the risk. Following the introduction to the fact, the prospect enters into a relationship with it. Personalizing demands that the potential risk in general are looked at as my possible risk. In essence, this medicalization process takes normal human variations and turns them into medical conditions.
Step 3- Motivation to Informing Self-diagnosis Once the potentiality of a risk is established through personalization, the next step for marketers is to change the status of the potential risk from possible to probable. This is achieved through an objective self-assessment: a self-diagnosis through a checklist or other tools such as questionnaires that give credibility to the concerns of the patient, finalizing the self-diagnosis stage.
Step 4- Convincing the Doctor, the Critical Moment Dumit coins the term “Pass through persuasion” to describe the stage that precedes the self-diagnosis. At this juncture, the patient has been equipped with the appropriate grammar (vocabulary) and tools to acquire the prescription drug they believe they need. DTC advertising, tests and checklists have confirmed their symptom concerns, and any resistance on the doctor’s part is thus seen as a lack of knowledge or interest/time. The result is an increase in patients asking for and receiving prescription medicine.
Step 5-Branded Compliance This last step of the medicalization process refers to a sense of loyalty gained by the patients towards the prescription drug they are on. After having convinced their doctor to prescribe them the pharmaceutical drug, it is imperative for drug companies that the patients stay on the prescriptions and refill them routinely. This endorsement of prescription drugs reinforces the notion that a life on drugs is normative.
Increased medicalization and the field’s allegiance to prescription drugs have resulted in patients experiencing their bodies under a pharmaceutically influenced paradigm. Essentially, One’s body is susceptible to invisible risks that are silent, waiting to be evaluated with the potential of having a variety of disorders. Health is thus a sign of concern, and “treatment is neither an imposition or a choice, it is increasingly ordinary” (Dumit, 60).