Editor’s Corner: With 'disease awareness,' pharma pushes ethical boundaries

Drug Discounts

The tragic death of a pharmaceutical salesman in India has unveiled a disturbing look at the intensely pressurized environment within the drug manufacturing industry--particularly in countries like India where "disease awareness campaigns" appear to push ethical and moral boundaries. 

An investigation by the New York Times peeled back some of the unsavory layers of Abbott's culture following the suicide of Ashish Awasthi, a 27-year-old Abbot Laboratories salesman who left a note suggesting his company's pressure to meet sales goals had become too much. 

It appears Awasthi was not the only one feeling that immense pressure. Former sales reps and managers told the Times that they had been fired after resisting corporate pressure to use ethically suspect sales tactics. Several former sales managers complained to Abbott’s ethics and compliance division and were subsequently fired, losing a coveted position in India. Some claimed they felt pressured to pay kickbacks to doctors out of their own pocket in order to boost sales.

The Times investigation also unearthed several seedy yet all-too-common practices used by the company to boost drug sales.

One of those practices is the use of “health camps”--a term that carries a fairly sinister connotation on its own--where individuals are administered blood tests. Abbott classifies the sponsored camps as “disease awareness programs,” but emails obtained by the Times signal quite the opposite. One message from a marketing manager indicates sales reps were required to conduct a minimum of three neuropathy camps each quarter, which “will go a long way in promoting Surbex Star,” Abbott’s neuropathy vitamin that was lagging behind sales projections.

Abbott India’s public affairs director told the Times that there was no “explicit or implicit understanding” that doctors would prescribe Abbott products in these sponsored camps, even as emails showed sales reps exclaiming that a doctor in one camp had prescribed Surbex Star to all 30 patients who tested positive.

Turns out, these camps have been a serious windfall for other Abbott-manufactured drugs. In February, MedPage Today reported that Abbott had used health camps as a basis for a survey that indicated 1 in 10 people in India had a thyroid disorder. That survey fueled a widespread and effective national campaign titled “Think Thyroid Think Life,” in which celebrities encouraged early screening. But experts say the health camps attracted a disproportionate number of sick individuals, skewing the survey results to make the disease appear more widespread.

That minor detail hardly put a dent in the campaign. Sales of Abbott-manufactured Thyronorm increased drastically by 2015, capturing more than half of the market share in India, according to an annual report, which proudly noted that the company had conducted 2,800 thyroid clinics and 5,600 thyroid camps in the last year alone.

"This blurs the line between what's marketing and what’s a public-health message, and that's why disease-awareness campaigns are particularly insidious and disturbing," Lisa Schwartz, M.D.,co-director of the Medicine in the Media Program at The Dartmouth Institute for Health Policy and Clinical Practice, told MedPage Today.

I know what you’re thinking: Yeah, but that’s India. There aren’t any “health camps” in the United States.

True, but disease awareness campaigns come in different shapes and sizes. Just as Abbott India sponsors the Indian Thyroid Society, Abbvie, which makes Synthroid, sponsors the American Association of Clinical Endocrinologists’ Thyroid Awareness campaign. In fact, disease awareness often doubles as a marketing campaign disguised as “social responsibility.” Pharmaceutical companies have written the checks for disease campaigns targeting binge-eating disorder, ADHD and restless leg syndrome, according to Scientific American.

That’s not to say disease awareness campaigns don’t offer value, but the aftermath of Awasthi’s horrific death points to some frightening ways in which manufactured awareness contributes to a pressure-cooker culture driven by ulterior motives. What’s more, Abbott India appears to have not just ignored complaints to its ethics and compliance department, but actually taken punitive action against those who raised concerns.

Moreover, the company’s willingness to push legal and ethical boundaries makes you wonder where drug manufacturers draw the ethical lines, both in the U.S. and abroad.