rman. then david cameron takes questions from the house of commons. ted cruz was the featured speaker today at this♪ announcer: as we our -- as we our guest is dr. adriane fugh-berman. she jeeps and all on the lobbying practices of the pharmaceutical interest -- keeps nra on the lobbying practices of pharmaceutical industry/ brian: if you could change one thing about the pharmaceutical industry and its relationship to doctors or patrons, what would you do -- patients, what would you do. dr. fugh-berman: i would get

them out of educating consumers they are unable to be objective and there are a lot of marketing messages in the education that they do with doctors through continuing medical education which is required for most physicians or through disease awareness initiatives aimed at other consumers or health care providers -- either consumers or health care providers. there is a lot of distortion that happens because of the pharmaceutical industry and we need to make sure that the information that health care providers and consumers have is accurate. we will never get that from pharmaceutical companies. brian: why not? dr. fugh-berman: they are legally obligated to represent interests of their shareholders and as much or as they try to

pretend that they are in a partnership with physicians and health care providers and they are on the same side in terms of helping patients, they are really quite different. pharmaceutical companies are legally required to represent the best interests of shareholders and physicians are legally required to represent patients. occasionally interests align but often they do not. brian: what is one thing that happens between the pharmaceutical companies and doctors that would give us an example of what you are talking about? dr. fugh-berman: for example the promotion of a drug start seven or 10 years before a drug comes on the market. while it is illegal and marketed drug before it has been approved by the fda, it is not illegal to market the disease. drug companies have invented diseases or exaggerated importance of certain conditions

or of a particular mechanism of a drug. and then blanketed medical journals and medical meetings and other venues with these messages that are meant to prepare the minds of clinicians to accept a drug. and to prepare the minds of consumers to accept a particular condition. so even if a drug is not mentioned, the condition itself can be sold. this is really a problem. there are many conditions, for example, social anxiety disorder or overactive bladder syndrome or excessive sleepiness, but are conditions that have either been created by pharmaceutical companies or exaggerated. it does not mean that some people who not have uncomfortable symptoms but actually creating a disease that

do not have uncomfortable symptoms but actually creating a disease -- do not have uncomfortable symptoms but actually creating a disease distorts information. dr. fugh-berman: --brian: what is low t? dr. fugh-berman: that is what the conditions are called for consumers. in the medical literature of the call it late onset hyper gonadism. men's testosterone levels go down over time but there are a variety of symptoms that have been attributed that have a lot of overlap with aging. some of the questions on questionnaires on the internet will ask things like, do you fall asleep after dinner?

anybody would fall asleep at some point after dinner. is your performance less than it was five years ago? do you feel like you have as much energy as you used to have? we have everyone in my office take the quiz and everybody field including the 23-year-old women. brian: what are the times of drugs that they sell to take care of the -- kinds of drugs they sell to take care of the problem? dr. fugh-berman: testosterone products are sold to amend to increase sexual function and energy in all of these other things and not only is there little evidence that they hope with these things -- and my group is working on a systematic review of the benefits of testosterone -- not only is little evidence that this helps but testosterone can cause fetal blood clots and may increase --

fatal blood clots and may increase the risk of heart attacks. this is not a benign drug and surging in a for an invented condition, the benefits are not -- taking any drug for an invented condition, the benefits are not there. unfortunately there is a lot of illegal off label promotion going on here. the testosterone story reflects -- and the estrogen story as well. for many in the 80's and 90's, one out of 501 out of four american women -- five or one out of four american women were menopausal were taking hormone therapy. example of other symptoms, there is no evidence that there --

there are a couple of other symptoms but the reason no evidence and when we performed a trial we found that it increased heart attacks and strokes and breast cancer. brian: you say we. where are we located? dr. fugh-berman: i am talking about the scientific community. the result of a disconnect between what science has found and what physicians and health care providers are doing. medicine is a strong culture and it takes a long time for us to drop therapies that have not been shown to work or accept therapies that have been shown to work. we are a culture that is slow to respond to science. brian: where did you get your medical education? dr. fugh-berman: i got my medical degree at georgetown

university medical school. i did a family medicine internship in the bronx in a program called the residency program in social medicine. brian: you still practice? dr. fugh-berman: not in many years. brian: you started an organization in 2006 called pharmedout. what does that mean? dr. fugh-berman: in 2006, all 50 states and washington, d.c. had sued a subsidiary of pfizer for illegal promotion of a drug. the attorney general did something interesting, the attorney general of all of the states decided to use some of the settlement money to fund educational initiatives for practitioners and consumers on inappropriate pharmaceutical marketing practices.

i got one of those grants and in 2006 we started pharmedout at the georgetown university medical center. what we do is to promote rational prescribing and expose inappropriate marketing tactics. brian: are you for the doctors to use or for the patient studios? -- patients to use? dr. fugh-berman: it is for the providers including nurses. but we also have fact streets -- sheets and information for consumers. brian: how do people get to that? dr. fugh-berman: pharmedout.org. brian: there is video on your website and i want to run some of it and have you explain it. the first thing is that anybody can see this, r a drugep -- a dr

ug rep talks and they are incognito. dr. fugh-berman: one of the thing that informs as well as we have insiders that give us information about industrywide practices that are not very well known. in this case, one of the drug reps in the video is currently working and did not want to lose his job. brian: how long ago was this reported? dr. fugh-berman: i believe it was 2007. brian: is it still relevant? dr. fugh-berman: absolutely. rep: generally speaking every office wants samples and for me that is accessed, i am just here to give you guys samples. you give them a blurb or two.

and of course samples of other things are strategies we have. we employ the same strategy with the antipsychotics that a drug dealer employees when they are selling crack which is that the first one is free and then and then you are -- then you pay and then you are hooked. brian: how big a deal as the sample business? i have had a doctor say here are some samples that will take you the first months. dr. fugh-berman: samples are the most effective marketing tool that pharmaceutical companies have. you might notice that they are always for drugs taken over a long. of time and often -- long period of time and often for the most expensive drugs. you do not realize what a strong endorsement it is that the patient is thinking, this is my

doctor and they know me and my history and they have gone through the list of things that would be good and chosen this particular drug. so it is a very powerful endorsement and if you are doing well on the drug, neither you nor the physician wants to change it. it is an extremely effective marketing tool but it actually gets in the way of physicians the wing about and prescribed -- knowing about an prescribing drugs that are older that might be just as good or better or using a non-pharmaceutical therapy like diet and exercise. it has been shown that to increase rational prescribing among residents, businesses and training, that you can give -- physicians in training, the they will keep getting the drugs that are in the sample closet even if they know that this is not the

preferred drug for the condition. they will give the sample because it is in the closet. brian: do they get a kickback? dr. fugh-berman: no, it's just that you get goodwill from the patient, everybody loves to get something free. it is a goodwill gesture but are no one dr. that makes music -- but i know one doctor that makes cds. we do not have to give free things, we should give good medical care. brian: what should a patient sued to a doctor if he says or she says here is a bunch of medicine? dr. fugh-berman: patients who give samples back and said they would prefer to have a time tested drug. brian: there is a fellow here named douglas. dr. fugh-berman: he used to work

for the pharmaceutical industry in a variety of jobs. brian: you mentioned this earlier, off label, and we will watch him talk about this. dr. fugh-berman: you have -- douglas: you send the reps and you talk in the doctor starts explaining and then he says, didn't they say that you have a new drug in this area? we may have something. i cannot discuss it with you however, i can have the company contact you. reporter: there is not a distinction so it is to their advantage to promote off label use. brian: who says they are not supposed to? dr. fugh-berman: the fda approved drug for a particular indication could mean that the fda has decided that for this

particular condition, the benefits outweigh the risk. but physicians and other prescribers can prescribe a drug for any purpose that they want. if a doctor wants to give chemotherapy for a cold they are allowed to do that. often marketing is often labeled so it is illegal to provoke a drug for something other than what the fda has approved it for what it is actually commonly done. that will not be done on a tv advertisement but it might be done by sending key opinion leaders to medical meetings or have them write articles in the medical journal saying that an anti-seizure drug is really great for headaches or really great for depression. we have free speech, that is allowed, but i think people do not realize how often that information has its genesis from a marketing department. it is a real issue for many

drugs including drugs for rare diseases that companies get additional -- they get expedited approval under certain circumstances, for example drugs for rare diseases, but once a drug is on the market, a physician can prescribe it for anything and there is a lot of opportunity there for widespread use for conditions for which the benefits have not been shown. brian: a representative of a pharmaceutical company cannot or something for all label but a doctor can use it. determined that? -- off label but a doctor can use it. determined that? -- who determined that? dr. fugh-berman: related goal is negotiated between the fda of the company but the fda decides. what you hear the doctor talking about is that drug companies

have many ways of convincing physicians to ask for all label information. a physician cap -- off label information. the physician can ask for information r even though the rep cannot ask for it. brian: what is your general view of the companies? dr. fugh-berman: there are a lot of large companies and small companies as well but this is a multibillion-dollar business. drug companies really have a lot of money to spend on promoting their drugs. it has been said that the best drug will not really needed a lot of promotion. some researchers have said there is an inverse relation between hogmanay drug is and how much promotion need. if you have a cure for pancreatic cancer, you will not need to sell the drug but if you

have the sixth mutual drug in a category that is in widespread use -- me too drug in a category that is widespread use, you will need to market it. not every drug is a breakthrough drug, not every drug is a life-saving drug. in fact there has been very little innovation unfortunately and drugs that have come out of the pharmaceutical industry in the last couple of decades. we have asked some really wonderful drugs but we also had a lot of drugs that are not necessarily the greatest drugs. there are 10,000 drugs on the u.s. market and most physicians are only familiar with about 100 of those and those tend to be the most promoted drugs. they are not necessarily the best drugs, they are just the most promoted. brian: what is the biggest drug company in the world?

bureau? -- do you know? dr. fugh-berman: i am not sure. brian: what are some of the biggest ones? dr. fugh-berman: pfizer, johnson & johnson, eli lilly. brian: are they well-regulated by the fda? i used the word well on purpose. heavily, not heavily? dr. fugh-berman: the fda is quite overburdened. we have to regulate the approval and the promotion of drugs and foods -- they have to regulate the approval and promotion of drugs and foods and medical devices and they are understaffed and underfunded. the amount of money that is spent on promotion completely dwarfs the amount of money that the fda has her the nih has -- or the nih has. they cannot keep up, ads are not

pre-wvetted by the fda. the get one million pieces of promotional material year. -- a year. consumers can report illegal promotion by drug reps, illegal promotion by physicians, or misleading advertisements. brian: i am going to show an ad. we do not take on these companies or ads for any other reason than to ask you about the information. v.o.: any prescription may increase the chance of heart attack or stroke. this increases if you have heart disease or risk factors like high blood pressure.

all increase the chance of serious skin reactions or stomach and intestine problems like bleeding or ulcers which can occur without warning and can cause death. with any of these medicines, the elderly are at increased risk for stomach bleeding. the old freed arthritis pain but since individual results may vary, having options is important -- these all freed arthritis pain but since individual results may vary, having options is important. the fda has stated that for certain patients, celebrix's benefits outweigh the risks. brian: why does a company have to put all of that in the ad? dr. fugh-berman: in this particular case, it is related to inhibitors that were taken off of the market.

they are clearly trying to universalize the risks of celebrix by putting it in context. nonsteroidal anti-inflammatory drugs, things like aspirin as well as some other prescription drugs as well. this particular class of drugs does have an increased rate of heart attack which is one of the reasons that viox was taken off the market. since the late 1990's, we are the only country besides new zealand that allows direct to consumer drug advertising. companies to have to mention at least some of the risks in an ad but they do not necessarily mention all of them. brian: you mean -- let me run another added because this is one that a lot of people talk

about because of the amount of time spent telling you things that will happen to you if you take this. it is a non-smoking drug. v.o.: herb quit smoking. talk about a doctor about -- to a doctor about chantix. some people have agitation or suicidal thoughts or actions. if you notice agitation, hostility, or changes in behavior or if you develop suicidal thoughts or action, stop taking it and call the doctor immediately. talk to your doctor about a history of depression which could be worse. some people have allergic or serious skin reactions, some of which could be life-threatening. if you notice swelling of the face or mouth or throat, call your doctor right away. tell your doctor wha medicines you are takingt. doses might be different if you

have kidney problems. patients may notice strange dreams. use caution driving and operating machinery. it should not be taken with other quit smoking products. brian: i am sure you have seen that before. you watch these on television, a lot of them are on the evening news on the national networks, and you go, why would they take a chance? i should smoke. i should die from cancer instead of kidney problems and mental health and suicidal depression. dr. fugh-berman: these ads are very effective in one of the reasons is that if you are showing peaceful -- and one of the reasons is that if you are showing peaceful images people tend to focus on that. this is a drug that can cause psychiatric problems and there has been a move by some drug companies to try to cast

nicotine addiction is a chronic disease so that in an effort to make -- as a chronic disease so that in an effort to make them pay for smoking cessation products for a long. then of time instead of -- long period of time instead of a short period. a lot of people that quit do so cold turkey. brian: requires this? could they do an ad and not that in it? dr. fugh-berman: -- put that in it? dr. fugh-berman: you are required to do some side effects but not all of them and the company can choose. brian: what is the advantage of the company? dr. fugh-berman: it is that they get to choose which of the serious adverse effects that they showcase and the ad and

sometimes they might leave out some of the serious adverse effects that they don't really want to put in there. in the ad you have to refer the viewer whether it is a print ad or tv ad, to another source. sometimes you might see an ad that says for more information see our print ad in some magazine and probably nobody is going to look that up. but you have to refer the viewer to a website or to another source that has more complete information. brian: i have looked close up and i have seen as much as three pages devoted to the side effects. who requires that? dr. fugh-berman: the fda. brian: what role did congress play in this? we were involved? did you just -- were you involved? did you testify? this was since the 90's?

dr. fugh-berman: 1997. directed consumer advertising was allowed before that but you would have to read the entire product label and nobody was going to do that. in the late 1990's there was a legal decision that opens the gate to direct to consumer advertising and promotion in the u.s.. and by the way it is not just advertising, there are many disease websites that are run by pharmaceutical companies and sometimes it is more or less obvious that they are the ones that are running these websites. a lot of what consumers believe and subscribers as well is really affected by what is available on the web. brian: what impact did medicare d back in the early 2005 on pharmaceutical industries? dr. fugh-berman: the government

is was, and remains the biggest payer of prescription drugs in the country. between medicare and medicaid, the v a heavy military and government workers -- the eighth and the military -- v.a. and the military and government workers the government pays the most. we are the only country whereby law the government is not allowed ilog to negotiate prices. -- by law to negotiate prices. brian: the veterans administration is allowed. dr. fugh-berman: some systems can but what the government really is not allowed to negotiate specific drug prices. they have a formulary so specific systems will have drugs that are on the formulary and those are the ones that are preferred for subscribers.

we spend more. brian: from the government through medicaid or medicare d be allowed to negotiate the price of drugs -- should the government for medicare d or medicaid the allowed to negotiate the price of drugs? why did congress do that? dr. fugh-berman: there was quite a bit of lobbying on behalf of industry. brian: what is your opinion of lobbying on the pharmaceutical industry? does it work for them? brian: yes -- dr. fugh-berman: yes, lobbying works well for them and so do the covert things they do. the education of consumers. do quite a lot of straight out lobbying as well. and also of government regulators. they really will try and a tactic that works. -- any tactic that works. brian: let's go back to your

website and some video, dr. douglas as a little piece where he talks about the competitive intelligence drug companies. dr. douglas: competitive intelligence is the process by which one company learns about and begins to understand the business activities, competitive business activities, of another company. for example if you will have drugs in the same area the doctor could choose between either drug and you might want to know, is that company coming out with a new indication? they have a new large study that will show that their drug, company abuse drug is not superior to company had -- company b's drug is now superior to company a. you want your own drug that is superior or all kinds of activities so that you can predict how much money your

company is going to gain or lose in the future. executives at wall street might talk about how their drug will compare against a competitor,. the kind of thing. brian:? comment? dr. fugh-berman: what he is talking about is a good example of promotion that does not look like promotion. they will look at what companies are doing and what constitutes marketing might be criticizing another company's drug. for example. i have a story about ghost writing in which i was approached by a medical education company, a vendor to pharma to put my name on an article that had written about interactions. and when i asked about the

genesis of this article i was told that the drug company was came up with, they had a drug that was going to come up for regulatory approval in a few years and it had fewer drug interactions. so this company was charged with posting an article in the medical literature that would talk about herb interactions and i am sure there were putting in other articles to talk about what problems it had in terms of drug interactions just as a way to prepare the market for another drug that had fewer interactions. that is not something that you would necessarily identify as promotion. the article does not mention the drug that is actually being targeted. it was a drug that ended up not being approved in the united states anyway. it is the kind of promotion that can happen many years before the

drug comes on the market. brian: i found this on wikipedia, the list of the largest pharmaceutical settlements. the top one at the moment 2012, is glaxosmithkline, $3 billion. $1 billion criminal, $2 billion civil. off label promotions, failure to disclose safety data, kickbacks false and misleading statements, reporting false prices and underpinning rebates owed under the medicaid -- underpaying rebates owed under the medicaid program. did you follow that? dr. fugh-berman: i am a paid expert witness in several legal trials including one on plenty of -- including one. those seem like large numbers

they are massive settlements but when you look at how much money drug companies have made, the amount of money they have paid is quite small. and it takes so long for cases to make their way through the legal system that it is easy for companies to say that we do not do that anymore, nobody does that anymore, those are the battle days, they were a few bad apples, -- bad old days, there were a few bad apples. although the tactics have changed, pharmaceutical companies are endlessly creative but they are still promoting in ways legal and illegal. brian: on the same list there is a 2009 pfizer $2.9 billion off label promotions and kickback. 2009, eli lilly $1.4 billion off label promotion.

it does not seem to have much effect. dr. fugh-berman: that is true. the department of justice has gone after many companies and required them to sign corporate integrity agreements where they say they will train employees and disclose the names of doctors that they are paying and etc. but i do remember one judge in one of those fines with pfizer saying that it was such a large amount of money because of recidivism because they were violating a corporate integrity agreement. at the same time, they were under a corporate integrity agreement but were doing illegal things at the same time. brian: again, going back, has anybody ever gone to prison? some of these are criminal findings, has anyone ever gone to prison? dr. fugh-berman: not as far as i know. brian: what do you think about off label promotion?

is there any reason why someone shouldn't say this could be used for something else? dr. fugh-berman: off label promotion absolutely should be illegal and unfortunately the fda is now allowing drug reps distribute reprints which i think is a terrible thing. not all off label uses are bad. for example often drugs are not tested in pregnant women or children but sometimes we have to use those drugs. that is an off label use but it might be a justified use. it is very important that information about off label use is generated by physicians and the mother: scientific community and not by pharmaceutical companies. the avs -- and the scientific community and not by pharmaceutical communities. these have not been approved by the fda.

some use of off label is absolutely justified. brian: by the way, and there are so many varied accounts on the internet about this, i question whether i should use these numbers, but the latest in 2014 ranking of the top biotech and pharmaceutical companies based on revenue, johnson & johnson's number one at $77 billion in novartis at $60 billion pfizer $51 billion. clusters of, $41 billion -- glasgow's cliff -- glasgow smithkline. $41 billion.

dr. fugh-berman: we spend more money on drugs in the united states than in any other country. and we certainly use a lot of drugs. and yes, there are some of these businesses, they are extremely successful at the very high profit margin on drugs. there are a lot of companies large and small. there has been in small specialty companies with niche drugs. brian: what is the difference between a patented drug like lipitor and then the pound runs out and you go to the generic? -- patent runs out and then you go to the generic? dr. fugh-berman: by the dominant drug comes on the market there are usually seven or 10 years of patent life left. but there are many techniques

for extending patent life in some ways of doing that are for example putting out delayed release preparations. a company might do an immediate release and then they do a controlled release and then an extended release. that is a way of extending patent life. sometimes companies will rename drugs and get a new indication for them, sometimes one that they invented. for example prozac was a blockbuster drug and made a lot of money for the company. brian: eli lilly? dr. fugh-berman: eli lilly. so before the patent were off the company created a condition w -- wore off the company created a condition and released a drug called service on -- sera fim which is prozac.

it was indicated for premenstrual disorder and what that meant was even when there was a generic available for prozac there was not a generic available for it even though it is the same drug. that is another strategy for patent extension for a patent extension, it is actually a new patent. there are other ways to protect profits. brian: some of what we are talking about is negative to pharmaceuticals. i am from indiana and eli lilly is based there and they give hundreds of millions of dollars away throughout my lifetime from their foundation, mostly to the state of indiana. how much of that is done by other pharmaceutical companies and is that a positive thing? dr. fugh-berman: i think that most pharmaceutical companies have charitable giving programs. that is certainly something that

makes their employees and other people feel good about the company. i am more concerned about the money that is spent on education and in public/private partnerships where they are actually involved in educational drugs that they make money on. what if they are giving money to flood -- but if they are giving money to flood victims or to support cleft lip and public surgery, those are good things -- how let surgery, those are good things -- palate surgery those are good things. brian: some drugs cost as much as $5 billion to create? dr. fugh-berman: those tend to be exaggerated because they include all of the failures of drugs that did not end up on the marketplace. but companies are truly at least three times as much on marketing

as they do on research and if they spent less on marketing they would have more money available for research and development. brian: what does the pharmaceutical industry think of you when what you do? dr. fugh-berman: i do not think they are very happy. i think we are effective at educating physicians and other subscribers and consumers about some of the really unethical forms of pharmaceutical marketing out there. we have been quite successful in the materials, we have published many articles in peer-reviewed literature. i think what is most effective is the grand rounds and educational events that we do as physicians. most physicians want to do the right thing by patients, we want to give them accurate information and once they see how they are being related by pharmaceutical companies, they react often with anger towards those companies and with a

commitment to try and get more objective information about drugs. that has been very satisfying work that we have done. there are lots of ways in which pharmaceutical companies use social psychology techniques not only with drug reps but with the use of opinion leaders and medical literature that is really a way of manipulating how people think about drugs. brian: your organization started because of the attorney general and the warner-lambert decision. how much money did you get originally? dr. fugh-berman: $400,000 over two years and i was not really intending to keep the project going necessarily after that time. but we had an international conference on whether the

industry should fund continuing medical education and a lot of people came and paid registration fees so that got us a little bit of money. and also we got individual contributions and the project has alive largely because of individual contributions and some internal grants from georgetown as well. it has been really wonderful every person that i was paying on the attorney general grants stayed on as a volunteer after we ran out of money. . even the work-study student. brian: how much is your budget? dr. fugh-berman: about $60,000 a year. and that mainly is to pay for our one project manager. brian: how many people work on the project that get paid? just one? dr. fugh-berman:.

one. [laughter] but there are many other people that work and get paid. we have an international association but we are run on volunteer help. we have volunteer legal help, many students right now about 16 student volunteers who will be helping through the conference on june 11 and 12 and are helping with other things. we have really created an amazing volunteer movement. brian: is the conference opened to the public? dr. fugh-berman: yes it is. it will be at georgetown. brian: i want to go back to the website, this is a video of dr. susanna dobson and you mentioned earlier the business of medical writing, putting your name on something that a pharmaceutical company would write. dr. dobson: there are two different kinds of medical writing. there are people putting

together documents for fda and other regulatory agencies and also publications, medical writers. we have certificates in both. medical writers work directly for drug companies or they work for contract research organizations. with drug companies hired by drug company -- which are companies hired by drug companies to put together applications for new drugs. whether you are hired directly by a drug company or by a contract research organization, you are hired by the pharmaceutical industry. brian: anything wrong with that? dr. fugh-berman: these medical writers, many of them are women. the work either for medical education companies or directly for pharmaceutical companies. sometimes they are writing up clinical trial reports. what is more insidious is that they are involved in writing reviews and commentaries and

letters to the editor. this is a way that pharmaceutical companies can sway what physicians think by affecting the medical literature so they get an academic to find an article that they did not write or that they may have contributed something to. the ideas that are in the article are industry ideas and the person that actually wrote it which might have been susanna or another medical writer or usually not even credited on it are credited they might be credited for editorial assistant which is often -- assistance which is a euphemism for ghostwriting. brian: most people think well of their physicians. you are people talk of doctors people are suspicious now more than they have been but basically you like the position. -- position. -- physician.

if you have a bad physician, ohio are they better -- how are they benefiting? dr. fugh-berman: there is quite a lot of money to be made in promoting drugs for pharmaceutical companies but i have to say that most of the physicians being buried by pharmaceutical companies are not necessarily -- paid by pharmaceutical companies are not necessarily doing anything bad. they are being selected because what they are saying is in alignment with the companies marketing message. -- company's marketing message. they are not changing what they are saying. you can see how that would end up distorting medical information because the person who was saying, diet and exercise can precondition as well as a drug is not being flown to meetings. they are not having articles written for them. there is so much in terms of

resources that pharmaceutical companies have that they can sway the discourse in a medical journal. for example with an article comes out of that they do not like they can get six or 10 of the doctors that are on the payroll to write letters to the editor saying that it is a terrible study and nobody should pay attention to the study and it looks like that is just a part of the self-correcting nature of medical science when actually it is an industry initiative. that is very dangerous to public health because physicians who are reading what looks like a scientific debate not realize that one half of the debate was generated by industry. brian: there is a novartis, a large pharmaceutical company -- here is a novartis, large pharmaceutical company ad. i want to get your reaction.

brian: 127,000 of us, meaning i

assume when 27,000 employees. -- 127,000 employees. dr. fugh-berman: it is very important for companies, the level of trust is very important to them. you really want to be respected -- they really want to be respected and trusted but really they should not be pervading medical information. it is really not the best thing for public health. certainly they do a lot of good in terms of developing drugs but the actual assessment of those drugs and the choice of which drugs should be used or not used in patients, that has to be the medical profession and the scientific community doing that assessment. and by the way, the ad mentions lifespan having increased. it is true that lice that has increased -- lifespan has increased but since it is

calculated as an average. the main contributor was a decrease in infant mortality 100 years ago four out of 10 kids did not make it to age 10 and that is what has affected lifespan. drugs have contributed some to that but not as much as you would think. brian: what are other things that you have discovered over the years that pharmaceutical companies to about the educational -- do about the educational process? like an educator or a doctor or a nurse or whatever, how much money is transferred to the outside world to help the pharmaceutical company? dr. fugh-berman: quite a lot. pharmaceutical companies hire researchers to do research but they also higher positions -- hire physicians and nurses to speak to peers they hire

historians and ethnographers and bioethicists. in order to create a platform for increasing the trust of the public and to market drugs. there are an incredible amount of resources at work here. brian: how regulated you think the pharmaceutical industry is from congress? and should it be? dr. fugh-berman: we need to have more legislation and regulation, we definitely need to have more action on the congressional side and more regulation on the fda side and we need to have physicians and health care providers take back the field away from the distorting influence of industry.

there is a lot that congress can do here. there are a lot of problems, right now, for example because of the prescription user fee act, prescription companies are contributing a lot of money to the fda which gives him quite a bit of influence over the office -- them quite a bit of influence over the office. we are the wealthiest country in the world. brian: if i were for the pharmaceutical industry or i was a patient over the years i would say i would rethinking -- be thinking what about the good things that they have done? they had leukemia and they invented drugs and he is still alive. the have done a lot of positive things. dr. fugh-berman: there is often the misconception that my

project is against drugs and we are absolutely not against drugs. we are fully rational use of drugs and for the use of the best drug or the best therapeutic that works well for a particular patient. there are actually drugs that are underused. we want to make the people have the right information so that they can use the best therapies. the trouble is that even though there are good things that pharmaceutical companies have gone and the drugs they have come up with there is a lack of information about drugs that could be better because they are not promoted, they are not high profit or for whatever reason they are not known by health care providers. having control of knowledge is

what makes the difference here. there is information about drugs that is suppressed. and we cannot always assume that the newest and most promoted drug is the best drug. sometimes the best drug is an older drug and when you look at studies that have been done funded by the government as opposed to funded by industry that have compared older drugs with newer drugs, you often see that the older drugs are better. brian: a couple of minutes left. what do you do full-time? dr. fugh-berman: i teach in the department of pharmacology. i teach graduate students and a few undergraduate students. i teach about evidence-based medicine i teach courses in medicinal plants in pharmacology and nutrition and a variety of other things. brian: where is your home originally? dr. fugh-berman: washington,

d.c. brian: i asked how to you pronounce your name -- how to pronounce your name. why is it pronounced that with? -- that way? dr. fugh-berman: he came over when the full and true movies were popular -- fyu manchu movies were popular. brian: what do you think of the current crop of medical students? dr. fugh-berman: most of them are idealistic and want to do the best things by the patient's. -- patient. they are maybe a little more critical than when i went to medical school, at least i hope that is true. brian: the name of the organization's pharmedout.org.

our guest is then dr. adriane fugh-berman. -- has been dr. adriane fugh-berman. two teachers at georgetown university. -- she teaches at georgetown university. we thank you very much. dr. fugh-berman: thank you. announcer: four free transcripts or to give comments visit us at q&a.org. programs are also available as podcasts. as c-span marks 10 years of compelling conversations on q and a, here are some other programs you might like. ralph nader discussing his new book. dr. anthony faucchi talking

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