Spotlight on the Pharmaceutical Industry

Posted on by Corporations and Health Watch

Recent public and media attention has focused on the various ways that the pharmaceutical industry promotes its products, sometimes at the expense of public health. We describe a few examples here.


Big Pharma on the Big Screen: Pharmaceutical Promotion Goes Hollywood

According to an article on February 25, 2007 in The Philadelphia Inquirer, the new film Innerstate, which focuses on three sufferers of rheumatoid arthritis, psoriasis, and Crohn’s disease, was produced by Centocor, Inc. Centocor is a subsidiary of Johnson & Johnson and is the maker of Remicade, the No. 1 treatment for the chronic diseases featured in the film.

According to Michael Parks, the executive producer of Innerstate and Director of Public Relationsat Centocor, the film is simply another form of patient education: “This is not about Remicade. It’s about elevating public awareness of these conditions.”

However, critics maintain that a movie ultimately staring a pharmaceutical product is the latest and most insidious way of undermining the prescription decision-making process. According to Alexander Sugerman-Brozan, Director of the Prescription Access Litigation Project, the production of Innerstate suggests a “questionable trend in health information.” He added, “We need to be skeptical of disease-awareness campaigns that come from a company with a vested interest.”

As Sugerman-Brozan suggests, through the release of Innerstate, Centocor stands to gain from new demands for their prescriptions. However, because federal standards do not allow the explicit mention of the drug’s name in the film, the risks associated with the drug are also not discussed. Thus, patient demands for Centocor’s products are not based on full disclosure of the side effects consistent with this line of treatment.

In addition to the millions invested in direct-to-consumer (DTC) advertising on TV, radio, and print, movie production for the sole purpose of marketing pharmaceutical products directly to consumers is the latest trend undertaken by the pharmaceutical industry in an effort to increase sales. This practice is often known as “disease mongering.”

Pharmaceutical industry insiders argue that DTC advertising of prescription drugs helps educate patients and encourages dialogue with their doctors, but critics say that DTC advertising misleads consumers into believing they need certain medicines. Furthermore, they argue, DTC advertising is merely a marketing tool to increase sales. According to Charles Medawar of Social Audit, “Once you start advertising prescription drugs to consumers and generating demand from that end, really you just debase the value of evidence completely.” Medawar further explains, “DTC advertising allows for a huge market expansion, with people being prescribed drugs that are unlikely to benefit them. The expansion of the antidepressant market “is a symbol of what happened in this era as [companies] suddenly began to realize the only way [to survive] was through marketing and not through drug innovation.”

New Viagra Ad Campaign Shows Industry Commitment to Help Consumers Make Informed Choices

A new Canadian advertising campaign for Viagra, the erectile dysfunction drug produced by Pfizer, provides new insights into the industry’s claim that Direct to Consumer advertising helps consumers make more informed choices. A recent New York Times article described the latest campaign.

“Viagra spanglecheff?” says a man to a friend at a bowling alley. “Spanglecheff?” his friend asks. “Minky Viagra noni noni boo-boo plats!” the first man replies, with a grin that suggests he is not talking about the drug’s side effects. The ads end with the slogan, “The International Language of Viagra.”

As other drug companies market impotence drugs, Viagra has lost market share. In 2006, total sales for Viagra were $1.7 billion, about half in the United States. According to a representative of the Canadian ad agency that produced the new campaign, “It’s not as though we need to tell people what it does, because they already know. Consumers can fill in the blank for themselves.” Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group, had a different point of view. “In an ideal world, companies would have to sell drugs based on accurate and balanced information,” he told the New York Times. “That doesn’t seem to work well enough, so instead of that they’re substituting gibberish.”

New Study Shows Most Doctors Accept Gifts from Pharmaceutical Companies

Results of a recent national survey published in The New England Journal of Medicine found that the vast majority of US physicians accepted gifts from pharmaceutical companies. Of the representative sample of 3,167 physicians surveyed, 94 percent had some kind of relationship with a pharmaceutical company. Eighty-four percent reported receiving food or drink from a pharmaceutical representative, while 78 percent reported receiving free samples. Thirty-five percent reported receiving reimbursement for costs associated with professional meetings or continuing medical education, and 28 percent reported receiving payments for consulting, lectures, or enrolling patients in trials. Furthermore, pharmaceutical representatives particularly targeted some specialties: Cardiologists were more than twice as likely as family practitioners to receive payments, although family practitioners met more frequently with pharmaceutical representatives than did physicians in other specialties.

The pharmaceutical industry argues that giving gifts to physicians evolved as a necessary tactic in order to gain the attention of busy physicians and share information about new drugs. However, according to the activist organization, No Free Lunch, such relationships are driving the prescribing practices of physicians. In 2003, the pharmaceutical industry spent approximately $22 billion on marketing to physicians, nearly doubling the $12.1 billion spending in 1999. In response to criticism, in 2005 the industry cut back spending to $3 billion, demonstrating the potential impact of advocacy campaigns. Since the 1990s, the pharmaceutical industry has prohibited such perks as lavish trips for top prescribing doctors and in 2004 stopped paying physicians to attend industry-sponsored dinners and conferences. Additionally, the American Medical Association has also set limits to gift giving and has stipulated that all gifts, such as dinners and free drug samples, should benefit patients. However, both the pharmaceutical industry and the American Medical Association have responded to pressure by setting new guidelines for gifts. Robert Goodman, M.D., founder of No Free Lunch noted, “Gifts are gifts. Whether they benefit patients or not, they’re just freeing physicians’ other income in a way that creates indebtedness.”

No Free Lunch argues that both DTC advertising and the aggressive cultivation of physicians debases prescribing practices because decisions are based on exposure to pharmaceutical marketing practices rather than scientific evidence. Promotional materials, according to the group, do not objectively describe the product but are biased in favor of the drug being marketed. These biased materials may lead physicians to prescribe more expensive or less appropriate drugs. In response, No Free Lunch encourages physicians to reject all pharmaceutical promotional items and gifts, citing evidence that acceptance of such gifts influences physicians’ prescribing behavior and creates a relationship in which the physician will feel “indebtedness” toward the representative.

Interview with Lynda Dee

Posted on by Corporations and Health Watch

Lynda Dee is a Drug Development Committee member and founder of the AIDS Treatment Activist Coalition (ATAC). In 2003, ATAC joined forces with a coalition of other AIDS treatment advocates, scientists, doctors, and government officials to create the Norvir Pricing Campaign. Abbott Laboratories had recently announced a more than 500% increase in the price of Norvir, an essential component of combination protease inhibitor therapies for HIV/AIDS. The campaign argued that increasing the price of Norvir, would have a negative impact on AIDS patient care as well as the competitive market for the research and development of new HIV/AIDS therapies. In March 2004, the nonprofit organization Essential Inventions petitioned the NIH to permit competition to produce a generic, low-cost version of Norvir. The NIH subsequently held a hearing on the matter. Lynda Dee gave testimony at this hearing.

While the FDA ruled that it did not have the authority to intervene, Congress subsequently began an investigation into the price increase. Several months ago, Corporations and Health Watch staff member Sarah Bradley spoke with Ms. Dee about her AIDS activism, ATAC, and the general political context around the Norvir campaign. Excerpts are included here.

CHW: When did you start doing treatment activism? Was it with ACT UP?

DEE: I started twenty years ago with “AIDS Action Baltimore,” where I’m from. We started AIDS Action Baltimore down here before there even was an ACT UP.

CHW: As an activist, how have you worked with big pharmaceutical companies?

DEE: Well, we often work with drug companies to initiate expanded access programs so that they can make their drugs available to people who desperately need them before it’s actually FDA approved, which means before they get paid for the drug.

CHW: Can you explain the meaning of phases one, two and three in drug trials and how you worked to change this process in order to expand treatment options?

DEE: Phase one is when they make sure it doesn’t kill you. Phase two is when patients get the maximum tolerated dose. That’s the old way of doing it. And what researchers figure out is whether the drug is excreted more in your liver or the kidneys, or whatever system is involved with that. Because certain systems mean that a drug will have drug interactions or, require that the dose be adjusted because of those interactions.

CHW: Right.

DEE: And companies used to do Phase one. Do that. Finish. Phase two. Do that. Finish. And, you didn’t start the one until you finished the other completely. And what we tried to do was to say, “Look, let’s change the designs of these trials.” Sequential learning is not always the best way to do things when people are dropping dead. So they now have Phase 2-B drugs wherein while they’re doing the dose and looking at the interactions, also at the efficacy, and they use that data to help build better Phase 3 programs. The Phase 3 programs are about getting the drugs into a larger population, between 500 and 2,000 people (in AIDS anyway) to see what affects the drug will have and what other side effects turn up. So the more people you have in the trials, for the longer periods, the more you’ll see of the efficacy or non-efficacy and the side effects.

CHW: So expanded access is mostly about making the trials bigger?

DEE: Well, no. Expanded access comes after Phase 3. We try to get them to start it in conjunction with Phase 3 now. In those testing phases they’re very much trying to rule out different things that might really make the results confounded. So they try to be very scientific and not very patient friendly.

We’ve even pushed for things called OLSS’s, which are open label safety trials, where you give expanded access to the even sicker patients. The FDA wants to see more safety data before they’ll allow this expanded access program. Usually, because they want to make sure you’re really not going to do more harm than good.

I’ll never forget, when AZT was first approved, my husband died from complications of AIDS in 1987 and [it] was only for people that had had pneumocystis. Well, he had two AIDS-defining conditions but neither one was pneumocystis, so he couldn’t have access to AZT.

CHW: Why were they limiting its use to the treatment of pneumocystis?

DEE: Because that’s the only place they had ever tried. We’re about changing the old paradigms: years ago when you first tried AZT, they wouldn’t let you take it in combination with one of the drugs for cytomeglavirus that caused people to have blindness. So either you had a choice of going blind or trying this new medication. It’s very nice to have pristine trial results where you’re in a little jar somewhere, but you’re talking about real people.

CHW: Has the impact of the FDA and the pharmaceutical companies on human rights for people with HIV and access or health changed over the last twenty years?

DEE: To get the pharmaceutical industry to change any of these paradigms was like pulling teeth. These guys are conservative: a lot of money is riding on how they proceed. They’re afraid their drugs won’t get approved and they don’t want to take any chances with the bottom line. You can imagine what lawyers were telling them, or even other scientists.

So they were very afraid to change how they did business. But then they had these crazy activists that would show up and cause a stink and bad press and they had to do something with us. After years of meeting with them, they’ve really come around. They know that they have to deal with us, and it’s just part of the price of doing business.

CHW: How do the pharmaceutical companies react to you in these meetings?

DEE: They don’t know what to expect. They come in, they see a reasonable bunch of people, and they see that these people really have good ideas, they’re smart, they’ve been around sometimes longer than they have, and they’re like, “Oh, wow, this has been a very constructive process.”

CHW: What has it been like to work with academics?

DEE: If the pharmaceutical companies were afraid to change the paradigms for reasons of money and power, the academic investigators were very condescending and acted like, what could we possible teach them? It was really kind of funny.

CHW: And what is your perception of their relationship to the pharmaceutical companies?

DEE: They all worked for pharmaceutical companies. What usually happens is, when you have a new drug, you want to get the foremost researcher or physician that you can find to experiment with your drug [in order] to believe your results. So they get paid for it. That doesn’t mean the pharmaceutical company’s bad, or the investigator is bad.

Now there are a lot of researchers who have a conflict of interest. They own the company’s stocks. The thing of it is, as long as I know that you’re getting that money, maybe I’ll look differently at what you say and how you say it.

CHW: In what capacity did you work with the National Institutes of Health?

DEE: I used to be on the Executive Committee of the AIDS Clinical Trial Group at the NIH, which is the national and now international network of the government’s drug trials for HIV. The NIH is very byzantine — there [are] 22 different institutes; they don’t speak to each other at all. So the people that dealt with this — [the] branch that deals with innovations and new inventions — had never dealt with any community people before.

They treated us like it was day one of the movement instead of 20 years later. They were used to dealing with the universities and the patent issues and all that.

CHW: Tell me more about the announcement regarding the Norvir price increase in 2003.

DEE: They announced this increase over the Christmas holidays because they thought [it] would just pass through without a lot of fanfare. But instead, people were shocked and appalled. It was one of the most egregious increases.

There were a lot of people that had their $300 insurance co-payment increased to a $1,000 copay. And there are a lot of people whose insurance permits them only a certain number of dollars every year for drugs. So if Norvir uses it all up, then what about other necessary prescriptions? They’d have you believe that this 700% price increase had no impact anywhere. I can’t imagine that somebody would think they would be able to get away with this without raising some hackles. I don’t think they ever expected to get the outcry that they got from us.

CHW: And in response, didn’t Abbott announce they were giving Norvir for free to anyone who didn’t have drug coverage?

DEE: Right. That’s the Patient Assistance Program. Of course, we could never get them to say how many people were on their Patient Assistance Program.

CHW: Didn’t Aetna actually sue Abbott and then withdraw the lawsuit two days later?

DEE: Yes, there’s still another lawsuit pending. John Doe vs. Abbott Labs is still alive and well. They actually just won their motion for summary judgment against Abbott. So they may end up in court over this if they don’t settle it.

CHW: How did the decision of the NIH not to allow competition to produce a generic version of Norvir affect the campaign?

DEE: I don’t think we ever thought the petition was going to be granted. It was a way to get PR because that’s what you have to do to get anything noticed. I think that really helped us to get the concessions that we did.

CHW: So was your goal more that Abbott would roll back the price because of the pressure?

DEE: We really thought we’d be more successful in getting them to do that. That’s what we hoped for. And obviously we were extremely disappointed when we weren’t able to do that. We’re still disappointed.

CHW: So from your perspective at ATAC, what do you think was the primary obstacle in getting Abbott to lower the price of Norvir?

DEE: It was money, plain and simple. They were in it to make money, and we didn’t have the power to do anything about it. At the time, ATAC had ten volunteers compared to a pharmaceutical giant — one doing press releases, one doing the actions, and me doing the coordination and getting the testimony together, and it was all we did for months. That we accomplished what we did was unbelievable.

CHW: What were some of your biggest successes?

DEE: We got some Congressional support and one of the Congressional people got the NIH to hold this hearing [which] really put the issue on the map as far as the press is concerned. And if it ain’t in the press, it didn’t happen. It doesn’t affect anybody’s bottom line or market share. The other thing was that we were able to get the docs fired up. I think that made a big difference too because these companies sell their drugs through the sales force that visit[s] each doctor. And to have some doctors say, “Don’t bother coming back,” had a big impact.

CHW: In the Norvir campaign, your organization used different strategies: such as protests, petitions, and marches so you had all kinds of strategy going on. Do you think one was better than the other?

DEE: Who knows? We tried everything we could think of. We have a lot of good minds, just not a lot of money and not a lot of volunteers. We even had stockholders involved in our actions such as religious groups that held large stock portfolios. We’d ask them to go in and vote against certain things.

CHW: Do you think the demographic makeup of people with HIV/AIDs affected the Norvir campaign at all?

DEE: No. I don’t think it affected this particular campaign. I think it affected the government’s response. Reagan’s response was lacking from the beginning. My impression, and [that] of others at that time, was that the Reagan Administration didn’t care about homosexuals and was probably glad it was happening to that community.

They did nothing. I think they felt gays were a throw-a-way population. Same for people of color, drug users, urban populations. That’s my honest opinion.

CHW: So you think that’s pretty much remained unchanged?

DEE: Yes. It’s the syphilis of old, just a lot worse. They just have a problem in knowing how to discuss these kinds of issues. If you take a look at England and Western Europe, the minute there is an idea of an epidemic — they react. In England they sent brochures and pamphlets door-to-door that were very graphic, talked about how to prevent it, and nothing happened in Western Europe like it did here. It was like dynamite here how it spread through certain populations.

I think the devastation could have been avoided if everyone were able to: 1. discuss it clearly and in an adult manner, and 2. cared about the people that were actually getting it. I mean look at that Legionnaires disease outbreak. Two or three people died of it and look at how much money and how crazy they were over that. Or look at this Avian Flu: we’ve never even gotten [it] here. I mean, they just go crazy. But how come they didn’t go crazy over [HIV/AIDs]? I mean millions of people have died because of this.

Same in Africa. Do you think many Americans care what happens to people in Africa? I don’t think they really do.

CHW: What has your relationship been with Abbott Pharmaceuticals [maker of Norvir] since the campaign began?

DEE: They’ve been trying to give money away ever since this happened.

CHW: What do they want to give you money for?

DEE: Whatever we want it for. And you know, we didn’t even ask them for it.

CHW: So they can put it on their corporate response?

DEE: To show how well they get along with community. I don’t care what anyone says, when you take money from somebody, you’re then beholden to them. It’s just that simple.

CHW: So I take it you’re opposed.

DEE: Yes.

CHW: Do you see similarities between the kind of work that you do and campaigns against, say, like the Brady campaign against guns, or campaigns against tobacco companies?

DEE: Those are huge issues to the American public. I think that we’ve been able to accomplish probably just as much if not more as those campaigns with an infinitesimal proportion of the resources that those campaigns have.

CHW: Do you think that the general lack of response regarding the increasing prices of HIV medication has to do with people not relating to it?

DEE: Yes, I think so.

CHW: Some observers have made the argument that the AIDS movement proved that the pharmaceutical companies will work with Non Governmental Organizations. What do you make of that?

DEE: Well, I think that the AIDS movement proves that the pharmaceutical companies can be forced into changing their ways. But, it’s absolutely a battle, from both sides. I think the fact that we were a disenfranchised population that knew how to get a little PR and how to call our Congress people and knew how to make some noise [made] a huge difference.

CHW: So you don’t see a rosy future where the industry changes?

DEE: I see a future where they know they have to deal with us, and we’re part of the landscape now. Like I said, the drug industry wouldn’t think of doing something without inviting the community. I just wish that our government would be as receptive. The FDA [was] not what it is today; they are a lot less willing to work with people, and [to] think about new ways of doing things. Under Clinton they were great. But this [the Bush] Administration has been unbelievable. Had it been another Administration in power, we could have had a much more welcome audience. I mean, it’s a very precarious situation we find ourselves in with Big Pharma. Nowhere else in the world do they get away with this. Their prices are fixed everywhere else in the world but here.

And it’s just really unconscionable what they get away with. You know, I’m not sure that if Clinton had been President we could have gotten that petition for margin rights. I’m not sure what Administration would change that.

CHW: Do you find the work harder or easier than you used to?

DEE: I think it’s much easier. What’s harder now is that a lot of the old people are doing different things and there are a lot of new people and it’s just awfully hard to listen to some of old issues come up over and over again. But it’s easier to deal with the companies and it’s easier to deal with the government now. We’re just part of the fabric of things now. They wouldn’t think of having a forum without involving the affected community.

CHW: So, what’s next for the Drug Development Committee?

DEE: Well, we’re very excited about integrase inhibitors. Merck [has] been a pleasure to deal with. The issues around Vioxx are unfortunate for them because they’ve always been one of the most progressive companies. They’re known among the investigators as the “Prince of Drug Companies” because, when they develop a drug, they spend a lot of money on research and a great development program. They keep records of side effects in patients for years and years.

We’ve also been working with the Senate with regard to FDA reform, and I’m the ATAC person for that. We’re looking forward to changing paradigms, as always, and, as far as drug development, the way protocols are designed, the way they’re approved, and the authority the FDA has over some of these companies. So that’s what I’m doing.

CHW: Thank you. I appreciate your talking to me.

DEE: You’re welcome. I appreciate your looking into this. I’m sure that it will help somewhere.

Courts and Congress Limit Rights of Local Government to Control Handguns

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On March 9, 2007, the US Court of Appeals for the District of Columbia overturned that city’s longstanding handgun ban, issuing a decisionthat will allow the city’s citizens to have working firearms in their homes. In a 2-1 decision, the judges ruled that the activities protected by the Second Amendment “are not limited to militia service, nor is an individual’s enjoyment of the right contingent upon his or her continued intermittent enrollment in the militia”, setting the stage for a Supreme Court review since other federal courts have ruled differently. If the appeal does go to the high court, it would be the Supreme’s first case in nearly 70 years to address the Second Amendment’s scope. Washington Mayor Adrian Fenty has announced that the District will appeal the ruling, vowing, “We intend to do everything in our power to work to get this decision overturned, and in the meantime, we will vigorously enforce our handgun law.

In response to the court ruling, Paul Helmke, President of the Brady Center to Prevent Gun Violence, observed that “by disregarding nearly seventy years of U.S. Supreme Court precedent, two Federal judges have negated the democratically-expressed will of the people of the District of Columbia and deprived this community of a gun law it enacted thirty years ago and still strongly supports.” The NRA, on the other hand, applauded the decision, claiming that the “D.C. gun ban is a failure that costs innocent lives.”The court decision removed, at least for the time being, the right of municipal governments to ban handguns, further restricting the ability of local governments to regulate the gun industry. In 2005, Congress passed and President Bush signed the Protection of Lawful Commerce in Firearms Act, a bill that prohibits civil liability actions from being brought or continued against manufacturers, distributors, dealers, or importers of firearms or ammunition for damages, injunctive or other relief resulting from the misuse of their products by others. Several municipal governments had sued the gun industry for its negligent oversight of the retail distribution of handguns. The new law blocks Mayors from using courts to require the gun industry to absorb the costs of its products.

And in the Senate, pro-gun legislators looked to enact federal legislation that would further limit Washington, D.C.’s scope. Inspired by the Court of Appeals victory, and with the support of the National Rifle Association, Senator Kay Bailey Hutchison, R-Texas, announced she would reintroduce a piece of legislation aimed at making handguns legal in the District, a measure that previously passed in the House, but failed in the Senate.

New study shows benefits of local action

Even as the federal government acted on several fronts to restrict the ability of local governments to control handguns, a recent study from Milwaukee, Wisconsin shows the public health benefits of local action. In an article in the September 2006 Journal of Urban Health, researchers from the Center for Gun Policy and Research at the Johns Hopkins School of Public Health assessed the consequences of a decision by a gun store in Milwaukee to stop advertising Saturday night specials, cheap handguns frequently used in crimes. Prior to May 1999, a single gun store sold more than half of the guns recovered from criminals in Milwaukee. On May 10, 1999, the store decided to stop selling small, inexpensive handguns popular with criminals. According to the authors, over the next year, the “changed sales policy was associated with a 96% decrease in recently sold, small, inexpensive handguns used in crime in Milwaukee, a 73% decrease in crime guns recently sold by this dealer, and a 44% decrease in the flow of all new, trafficked guns to criminals in Milwaukee.”

The Marin Institute Takes On Big Alcohol and Wins!

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In September 2006, San Francisco’s Bay Area Rapid Transit District (BART) board of directors voted to reverse their previous decision prohibiting alcohol advertising on BART buses and trains. Following this announcement, alcohol industry watchdog, The Marin Institute, took quick action and launched a campaign to get BART to reinstate the ban. The Marin Institute noted that while BART officials pointed to the increased revenues that would be associated with the alcohol ads, they neglected to mention that allowing such ads would further expose young people to alcohol industry marketing.

Two recent studies have noted that alcohol industry advertising has a strong effect on youth and contributes to underage drinking. In January of 2006, the American Medical Association’s Archives of Pediatrics and Adolescent Medicine published a study by Snyder et al which found that the number of alcohol ads viewed was positively associated with the amount of alcohol consumed by youth. Each advertisement viewed raised the number of drinks consumed by 1%.

In December of 2006, the American Academy of Pediatrics (AAP) released a statement expressing serious concern about the effects of corporate marketing on youth. The AAP noted that youth view an estimated 40,000 advertisements per year and that exposure to advertising from the food, beverage, tobacco, and alcohol industries may significantly contribute to obesity, poor nutrition, alcohol, and tobacco use in young people. According to the AAP, youth spend an estimated $180 billion per year and influence an additional $200 billion of their parents’ spending per year. As a result, advertisers consider young people to be an important market and seek new and creative ways to reach them. With regard to alcohol, the AAP argued that with $5.7 billion spent per year on advertising and promotion, and an estimated 2,000 beer and wine commercials viewed annually, exposure to alcohol industry advertising “represents a significant risk factor” for youth. Referring to the fact that minority neighborhoods have five times the number of alcohol billboards as do white neighborhoods, the AAP further noted that youth of color may be particularly at risk.

Pointing to the risks for youth associated with alcohol industry marketing, on December 7, 2006 the Marin Institute and Bay Area community leaders came out to oppose BART’s decision. Because of the strength of their coalition and the size of their turnout, the BART board of directors reversed its decision to allow alcohol advertising on Bay Area buses and trains.

After their victory with BART, the Marin Institute continued to address outdoor alcohol advertising in San Francisco. In January of this year, the organization issued a report stating that CBS Outdoor, the nation’s largest outdoor advertiser and owner of outdoor advertising space in San Francisco, had blatantly disregarded voluntary alcohol advertising codes as well as its contract with the City’s Municipal Transportation Agency (MUNI) by placing alcohol advertisements near schools. The Marin Institute surveyed three of San Francisco’s school districts and found 15 alcohol ads on public transit shelters. Ads were also found near playgrounds and churches.

The Marin Institute stated in the report, “Extrapolating to the entire city (all 11 districts), we conservatively estimate that at least 55 ads are in direct violation of the CBS Outdoor and MTA contract. Furthermore, we conservatively estimate at least 81 violations of both contract and national standards city wide.”

The Marin Institute held a press conference calling on CBS Outdoor to immediately remove the ads and for the San Francisco Municipal Transportation Authority to enforce the terms of the contract. Shortly afterward, the offending ads were removed. In addition, MUNI pledged to disallow alcohol advertising in future contracts.

Between their successful BART and MUNI campaigns, the Marin Institute has managed to keep the Bay Area completely free of outdoor alcohol advertising on public transportation. Not only will their efforts significantly reduce the amount of such advertising youth are exposed to, but they demonstrate that community campaign pressure on public officials, advertisers, and corporations can lead to victories that protect public health.

The Big Apple Just Got Leaner – New York City Bans Trans Fats in Restaurants

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On December 5, 2006, the New York City Board of Health voted to ban the use of almost all artificial trans fat in the city’s more than 11,000 restaurants and fast food outlets. Harold Goldstein, the executive director of the California Center for Public Health Advocacy, told the New York Times that, “New York City has set a national standard” and already several cities and states have introduced similar legislation.

On December 5, 2006, the New York City Board of Health voted to ban the use of almost all artificial trans fat in the city’s more than 11,000 restaurants and fast food outlets. Harold Goldstein, the executive director of the California Center for Public Health Advocacy, told the New York Times that, “New York City has set a national standard” and already several cities and states have introduced similar legislation.How did New York City decide to act on trans fats and what are the lessons for health advocates engaged in other efforts to control corporate practices that harm health? First, some background: trans fats are used to enhance the crispness, stability, flavor and shelf life of many processed foods. Trans fats provide food companies with flexibility in food storage and preparation, thus contributing to profitability. By the late 1990s, about 40% of US supermarket products contained trans fats, showing how pervasive exposure was to the public at large.

In 1994, the Center for Science in the Public Interest (CSPI), a national advocacy organization, petitioned the Food and Drug Administration (FDA) to require that food manufacturers label the trans fat content of their food products. The petition was based on research showing that replacing trans fat with healthier oils could prevent between 30,000 and 100,000 premature cardiovascular deaths in the United States each year. Some researchers have suggested that replacing trans fats with healthier alternatives could also significantly reduce the incidence of Type 2 diabetes in the US.

In 1999, despite the opposition of the food industry, the FDA proposed to include the trans fat content of food on the standard food label. The agency claimed that strengthening food labeling was likely to yield significant health and economic benefits, including saving up to 5,600 lives and $8 billion a year.1 Three years later, the Institute of Medicine concluded that they could not determine a healthful limit of trans fat and urged action to reduce its presence in the American diet.2 In January 2006, the FDA rule requiring food labels to include information on trans fats went into effect, but the FDA has turned down requests to ban the product altogether.

New York City took on trans fat in 2005. According to the New York City Department of Health and Mental Hygiene (NYC DOHMH) Health Commissioner Thomas R. Frieden, “New Yorkers are consuming a hazardous artificial substance without their knowledge or consent. Trans fat causes heart disease. Like lead in paint, artificial trans fat is invisible and dangerous, and it can be replaced. While it may take some effort, restaurants can replace trans fat without changing the taste or cost of food. No one will miss it when it is gone.”

The department began its efforts with a year long education campaign to help restaurants voluntarily reduce trans fats. However, a survey before and after this voluntary educational campaign showed that overall use of trans fat did not decline at all. As a result, the Commissioner proposed the ban. Speaking on behalf of the ban, Dr. Walter Willett, Chair of the Department of Nutrition at the Harvard School of Public health noted, “If New Yorkers replace all sources of artificial trans fat, by even the most conservative estimates, at least 500 deaths from heart disease would be prevented each year in New York City — more than the number of people killed annually in motor vehicle crashes. Based on long term studies, the number of preventable deaths may be many times higher. Trans fat from partially hydrogenated vegetable oil is a toxic substance that does not belong in food.”

Some in the food industry supported the ban. Carnegie Deli owner Sanford Levine said, “We’ve been using 100% canola oil for 20 years because it has a better taste and is better for customers. It’s easy to replace artificial trans fat, it costs the same, and the food tastes great. Our cakes and other baked goods are already trans fat free. If we can do it, so can other restaurants.”

But others in the food and restaurant industry vigorously opposed the ban. Although no New Yorker ever walked into a restaurant to order a portion of trans fat, some argued that the ban would interfere with New Yorkers’ freedom. In an op-ed in the Daily News, Richard Berman, a food lobbyist and executive director of the Center for Consumer Freedom wrote, “the proposal to eradicate all artificial trans fats from every restaurant in the city is nothing short of hysterical.” It subjects the restaurant industry to a terrible case of regulatory whiplash. “If they can declare New York City a trans fat free nanny state by bureaucratic fiat, what can’t Commissioner Thomas Frieden and his minions ban?.. Maybe the radical solution is to let consumers not bureaucrats dictate what restaurants do.

In the months leading up to the vote, dozens of New Yorkers wrote impassioned letters to the editor on the subject, newspaper editorial boards took opposing sides on the issue, and hundreds of New Yorkers submitted documents or testified at public hearings on the subject.

In the proposal approved in December, the Board of Health made some concessions to the food industry, extending the time restaurants had to comply with the new rules. In the weeks and months following the New York City debate on phasing out artificial trans fat, several national companies announced their intention to eliminate trans fat from some or all of their product lines. These included KFC, Red Lobster, Olive Garden, Crisco, and Starbucks.

Lessons Learned for Changing Corporate Practices that Harm Health

So what lessons does New York City’s ban on trans fat in restaurants offer for public health professionals and advocates concerned about protecting the public against harmful corporate practices?

Local health departments can play a leading role in challenging harmful corporate practices. The campaign to phase out artificial trans fats was initiated and led by the local health department, which defined its mission as protecting the health of the public against significant threats. While advocates, researchers and health professionals played important supporting roles, the success of the effort depended on a Mayor and Health Commissioner who made public health a priority and were willing to engage in some battles to achieve their goals. Similar efforts in other jurisdictions to control smoking, restrict access to handguns, and reduce exposure to lead paint show the important role local officials can play in protecting public health against health damaging corporate practices.

Voluntary educational campaigns may be a useful starting point.

The health department was able to win over public support for the phase out in part because they first tried a voluntary campaign and were able to demonstrate that this effort was not sufficient to achieve desired public health goals. In some cases, voluntary educational campaigns may work, but beginning with this activity may help to mobilize support for stronger action should it fail.

Framing the issue as protecting people against involuntary threats helps to mobilize people. In the health department’s aggressive media campaign to win support for the proposal to phase out artificial trans fat, spokespeople emphasized that New Yorkers did not choose to eat trans fat. Since the product was neither labeled nor disclosed, the argument that consumers were choosing this product was harder to make. Comparing trans fat to lead paint and labeling it a toxic product was also a clever strategy, since New Yorkers had debated regulation of lead paint for more than 20 years and most New Yorkers understood and strongly supported government action to protect children against lead paint poisoning. Thus, framing policy debates in local terms may help to generate support.

Creating controversy can help to advance public health.

Debate about trans fat received extensive coverage in local newspapers, television and other media for several weeks. While food industry defenders and some libertarians opposed the proposal, many New Yorkers supported it. In the course of the debate, the topic changed from whether to ban trans fat to how best to do it and on what timetable. The conflict provoked discussion and engaged diverse constituencies in the issue.

Some public health professionals have a predictable approach to conflict: partnerships with all stakeholders, compromise, and a willingness to be “reasonable”. By staking out a principled position and sticking to it, the NYC Department of Health achieved its goals, educated the public and set an example for other local health departments across the country.

Forceful advocacy sets the stage for subsequent victories.

While the New York City Department of Health took the lead on this issue, its campaign to phase out artificial trans fat stood on the shoulders of previous advocacy. In 1994, the Center for Science in the Public Interest began a 12 year effort to win the FDA requirement for trans fat labeling on store-bought foods. In 2003, Denmark passed a law that made it illegal for any food to contain more than 2% transfat. A May 2003 lawsuit by Ban Trans Fat against multinational food company Kraft led to a settlement in which Kraft agreed to produce trans fat free Oreo cookies for school markets. Ban Trans Fat also sued McDonalds for false advertising regarding its use of reduced trans fat cooking oil. In 2005, McDonalds settled the case by agreeing to act to limit trans fat and to pay the American Heart Association to sponsor public education on trans fats. In 2006, the American Heart Association became the first major medical organization to urge a specific limit on trans fat in the diet. In 2006, the New England Journal of Medicine published a study that concluded that daily consumption of 5 grams or more of trans fats raised the risk of heart attacks by 25% and that many of the “large” size fast food meals served by McDonalds and KFC exceeded this 5 gram limit. (The study also found that a New York City McDonalds meal had the highest trans fat content of any site in the 20 countries tested around the world.)3

These various efforts helped to educate the public about trans fats, to convince policy makers that it was an issue that deserved attention and set the stage for more assertive actions such as the New York City ban.

Interview with Reverend Jessie Brown

Posted on by Corporations and Health Watch

Reverend Jessie Brown is minister of two congregations in Philadelphia and a community leader who successfully fought the introduction of Uptown cigarettes in Philadelphia in 1991. Working with National Association of African Americans for Positive Imagery (NAAPI), of which Reverend Brown is the founder and executive director, he and other community leaders charged R.J. Reynolds with creating and marketing a new tobacco product specifically to African Americans. Because of their campaign, R.J. Reynolds pulled Uptown Cigarettes from the market. Today Reverend Brown continues to work nationally in tobacco control. He was the lead plaintiff in a lawsuit brought by NAAPI against the tobacco industries for marketing menthol cigarettes to African Americans. His work has been featured on many major news outlets and broadcasted throughout the world. Reverend Brown is also the chair of the US World No Tobacco Day Committee.

CHW: How did you start working in tobacco control?

JBROWN: In 1989, R.J. Reynolds Tobacco Company announced that they were coming to Philadelphia to create a new cigarette that was going to be specifically targeted to African Americans. And Philadelphia was going to be the test market site for that cigarette. We formed a community opposition group that thwarted their efforts to promote this. In fact, they withdrew the cigarette totally. It never reached the market.

CHW:: This was the “Uptown Cigarette,” correct?

JBROWN: Right, that was Uptown. R.J. Reynolds proudly announced that they were going to create a cigarette that was going to be specifically for African Americans and they thought they were being sensitive by telling everybody that they are now paying attention to the African American community. Of course, what they’re failing to do — which a cigarette company always fails to do — is to articulate the deadly nature of its product. So they treated it as if they were selling graham crackers rather than selling something that was highly addictive and highly dangerous to the African American community. So yes, they announced it in the Wall Street Journal in December 1989. By January 19, 1990, R.J. Reynolds formerly announced that it was going to withdraw that cigarette.

CHW: So, no packs of Uptown cigarettes were ever sold. Is that right?

JBROWN: None were ever sold. That’s correct.

CHW: Did you ever actually see the cigarettes?

JBROWN: Yes, I have a pack.

CHW: How was Uptown specifically targeted toward the African American community?

JBROWN: The color [used in the packaging] is red, black, and green — African Liberation colors — with the predominant color being black; and, of course, the green and red stripes. Secondly, we believe (this is our interpretation) that the majority of people who probably would be using it were laborers and did not like to get their hands on the filters to make them dirty. They packed them upside down so that you didn’t have to flip them over, just knock them out, and you pick it up from the end that you generally light, and stick it in your mouth.

CHW: What strategies do you think contributed to the success of the campaign?

JBROWN: One, we moved very quickly to consolidate the medical interests, community interests, as well as the church interests in our opposing what R.J. Reynolds was doing. And in doing so, we beat them to the punch, garnering most of the support in Philadelphia to oppose them on the product, including getting Ebony Magazine who also put out a statement that they were not going to market the product. This kind of stuff had never happened before, period. No one in the tobacco control movement had ever stopped the industry from marketing a cigarette. We were the first.

CHW: Did you do most of your community organizing through the churches?

JBROWN: Well, a combination. We already had identified from previous campaigns, churches who were sympathetic to the mission of health promotion. And some of the city council members became involved, the local agencies — heart, lung, and cancer locally — took a high backup role and put their resources, time, money, and energy and staff into making certain that this campaign came off well.

CHW: What kinds of successful tactics did you use in the Uptown Campaign?

JBROWN: We took black paint and painted over cigarette billboards in neighborhoods and communities. And, of course, that was to get a message out that we did not want that kind of advertising in our neighborhoods. And billboards are the kind of thing you can’t turn off. They’re always on. And the only way we were going to get the upper hand on this was that those things be taken out of our community. We also had T-shirts and cap exchange programs. That was where we would take T-shirts and caps that had an alcohol or tobacco logo, or other kinds of paraphernalia and exchange it for a T-shirt or a cap that had a positive message. We did that in a number of places, and particularly around me going to court since I was the only one arrested for the “black washing” [billboard alteration]. That gave us an activity, and a way to attract people to come down to the courthouse.

CHW: You got arrested for altering the billboards? And you got people to come down to the courtroom?

JBROWN: Yes. We filled up the courtroom. And the outdoor advertising industry or the tobacco industry was not interested in really prosecuting, so all the charges were eventually dropped. But while they were shaking their sabers, we decided to use it for an opportunity for education — community education. And it was extremely successful. And a number of other groups around the country also picked up on the idea, and did it themselves as well.

CHW: I’ve spoken with someone who does research in Harlem about billboard ads and point of sale marketing, and she says that a lot of folks just sort of casually do this now, and if they see an alcohol ad, they’ll just tear it down off the phone booth, or paint over it, or put a sticker over it. Do you see a relationship between that and the activities you guys did?

JBROWN: Sure. We’ve given people permission to take charge of their environment and their community. You know, not everybody is willing to take charge of that. And in some places, it could literally be deemed vandalism or there could be of legal consequences to that, but at some level, communities should be in charge of the images that come into their community — not corporate America. And when corporations don’t do what they need to do in the best interest of the community, particularly tobacco and alcohol, then the community needs to take control of that process for themselves.

CHW: So it seems that public opinion of the tobacco industry has worsened.

JBROWN: But, it won’t stay there.

CHW: You don’t think so?

JBROWN: No. We have to make sure it stays there. Corporations, like everything else, have the ability to advertise their way out of this. We don’t have the advertising dollars that they do. They spend billions. We spend a few — you know — for every billion dollars they spend, we may spend a thousand dollars on advertising. So we’re talking about equal partners in this process. And over time, if we are not vigilant, they’ll be able to raise their image, cause nobody stays down on any organization forever. And we also have this mixed message thing going sometimes that somehow they’re doing the right thing. And some people buy into that.

CHW: You mean in terms of the so-called “tobacco education” that they do?

JBROWN: Yeah, but we know — for those of us who are directly involved with them, we see their advertising campaigns, and we know that they are still going after young people. And we know that it’s in their best interest to do so because they would have no customers in fairly short order if they didn’t replace the ones that they lose.

CHW: So, what do you think the impact the “Uptown” campaign was on folks in Philadelphia?

JBROWN: Oh, I think it was more than just in Philadelphia. It was across the country. I think it did send a message to young people that the industry is out to get them. They were upset that the industry would come in and appropriate their culture, their language, and stuff like the Uptown Theater — one reason why they chose Philadelphia was because the Uptown Theater was a way to talk about fun. It has a historical context and perspective here. And a lot of young people were not too happy with that.

CHW: So the Uptown Campaign had a pretty significant effect…

JBROWN: Uptown, for a little bit, turned into a cottage industry to talk about the old community organizing, what we did, how it carried off, what the communities did. It is now part of some textbooks, as I understand it. They now teach about the fiasco of R.J. Reynolds in trying to market the Uptown Cigarette. And it’s used as a lesson learned in some schools, marketing schools. So it had a huge impact in a number of areas in addition to an impact on educating the community.

CHW: What kind of press did you get?

JBROWN: We had literally hundreds and hundreds of interviews done by our Media team; and what we did was identify six spokespersons who had it. You know, for instance, Dr. Bob Robertson was our statistics person. He knew the statistics. We all knew them, of course, but someone called and said they wanted to talk about statistical information, we’d put him up. I was kind of the community person, and I would talk about the community organizing part of it. We had a medical doctor talk about the medical issues around it. We had a politician talk about the political fallout that ensues from such promotion activities. So we chose our spokespeople well to meet various general media needs, but we did it based on what kind of message we wanted to get out, not necessarily what the media wanted to say.

CHW: And so how long did it take before R.J. Reynolds made the announcement that they were removing the cigarette?

JBROWN: In reality, thirteen days. That’s what we officially say. It was actually nine from the time that we formally organized to the time that R.J. Reynolds withdrew.

CHW: Tell me a little more about NAAAPI’s focus.

JBROWN: NAAAPI’s original notion was that we would deal with advertising images that were negative to the community which included tobacco, alcohol, and the media. As tobacco control money became available, and a lot of NAAAPI’s work then went into tobacco control.

CHW: So it has evolved into more of an organization that does campaigns directed towards the tobacco industry?

JBROWN: Correct. I would say tobacco and alcohol because we did a number of alcohol initiatives as well, and they’re on the website, too.

CHW: What do you think the similarities between the alcohol industry and the tobacco industries are in terms of targeting specific communities?

JBROWN: They’re working from the same playbook essentially. Their marketing techniques [of] wrapping themselves around community and social concerns and needs in order to sell their product is exactly the same between the two. Both of their products take a heavy toll on the community.

CHW: In terms of health?

JBROWN: In terms of health and life and quality of life. Because we know that, particularly with alcohol, and even with tobacco, the stresses that are placed on families create issues of domestic violence and neglect so even the quality of life is diminished by the product. You’ve got children who may be exposed, and the stress it puts on the family with kids who are sick, constantly sick; not to mention the prenatal issues that mothers have around giving birth and low birth weight babies.

CHW: I read a recent Washington Post article about new marketing used by the tobacco industry that involves naming cigarettes — alcohol flavored cigarettes — using gambling lingo. “Screwdriver Slots,” “Blackjack Gin.” Have you heard of this?

JBROWN: Yes. It’s par for the course. Again, all of those industries. The alcohol industry, itself, is trying to do that by taking some of its brand nicknames and making wine coolers using similar names, so that they would then break down the sensitivity, particularly of young people, to the aversion of alcohol, and get them involved. Again, they got to replace the customer base that’s dying off. Again, they’re working from the same playbook. And if they can crosspollinate each other, and sell cigarettes and alcohol and gambling, then that’s what they’ll do.

CHW: So, do you think there’s any conscious collaboration between the alcohol and the tobacco industry?

JBROWN: Well, it’s conscious in the advertising companies that they use, yeah. If you’ll look behind the scenes, you’ll find that a number of the advertising companies that advertise alcohol also advertise tobacco. They’re collaborating in that sense. They may not be holding meetings together, and I’m not so sure that they won’t, or are not; but I wouldn’t be a bit surprised if they did.

CHW: Is there any documentation of the alcohol industry’s marketing techniques?

JBROWN: Oh, absolutely. Go on the website. You’ll see Power Master Malt Liquor – targeted to young black men. We stopped them from advertising their product and that product [was] withdrawn from the market. That was a high alcoholic content beverage. Yes, alcohol does the exact same thing. They still do it. They just get away with it more often right now.

CHW: Do you see any similarities between the role of tobacco and alcohol corporations and food corporations in the black community?

JBROWN: The answer is “Yes, in one sense of the word.” And this is one of those things where I think the greater weight lies with personal responsibility as opposed to corporate responsibility. A soda, if taken in moderation, will not kill you. Unlike a cigarette, don’t matter how you take it, it could catch up with you somewhere down the line. I mean, you know, it’s that kind of thing. But I think we can win the battle. I would tone down the industry’s promotion of their product, and force them to better tell the truth in their marketing promotion. I also think we need a public promotion campaign that really promotes healthy lifestyles, health living, and its benefits. If we get just as good at talking about the benefits and promoting a healthy lifestyle as the industry does at promoting fast foods, or promoting alcohol, or promoting tobacco, then I think we can easily win the battle. It’s like, one of the things we were promoting, way back when, was if the tobacco industry was going to continue to advertise, they had to turn over a quarter to one third of all billboard advertising to public health messages about tobacco, which we would design and put up there. They didn’t want to do that. And the reason is simple. Our one good message would outdo three of theirs any day.

CHW: They’d rather have nothing up there.

JBROWN: They would rather have nothing up there. Correct. Because they can then go to putting it in magazines, and continue to give away T-Shirts and caps. They’re getting a lot of what we call “unpaid walking billboards.” You know, those whole campaigns.

CHW: Apparently, a lot of young people wear these items.

JBROWN: Yes. That’s why we had the T-Shirt/Cap exchange.

CHW: It was mostly young people that you did this with?

JBROWN: Oh, no. We actually got them from everybody. We did this in front of the police department. You know, the police department came out there and were bringing alcohol advertising off the walls of the police department to exchange. It was wonderful. And you actually get more adults who readily take this up than you do young people. Young people always take free stuff, but here we’ll get adults exchanging stuff with us, more than we did the kids. But the point was, we’re taking advertising off the street.

CHW: The tobacco industry has a history of financial involvement in the African American community, as well. Is that correct?

JBROWN: That’s correct.

CHW: So, in your own experience in Philadelphia, have campaigns and awareness and public education had an affect on how community groups and businesses deal financially with the tobacco industry?

JBROWN: Yes. For a number of those groups it has been “Hush money.” And some of the civic and social organizations that have traditionally led battles to stop the exploitation of African Americans were silent or in some cases even promoted the interests of the tobacco industry or the alcohol industry. Even Ebony magazine has not done due diligence in providing ongoing information about the effects of tobacco, even with the huge effect tobacco has on the black community. And, of course, they didn’t do it because they were receiving ad revenues from the tobacco companies. In the millions and millions of dollars.

CHW: Does your organization accept funding from tobacco corporations?

JBROWN: Absolutely not. Matter of fact, if a group receives tobacco money in any way, shape, or form — or alcohol money, we will not directly work with that organization.

CHW: What do you think the role of the tobacco industry and their policies and practices in exacerbating health disparities?

JBROWN: A high percentage of African Americans smoke mentholated cigarettes. And until we made a big noise in the last few years, no one had even tested the notion of whether or not menthol contributed to a higher disease rate which would impact African Americans more highly than others. We believe it does because all of the studies, even the industry studies, show that menthol in a burned form is, in itself, a carcinogen. So African Americans may have been deliberately targeted by the industry with a more addictive and more deadly product.

CHW: In closing, I’d like to ask, what are your thoughts on the potential of the tobacco industry to be held accountable for its impact on the health of the Africa American community, or the public health in general?

JBROWN: Well, there are two things that I think that can make that happen. One is that people really get upset over it. And two, we put a Congress in there who actually do their jobs to protect the public interest around these issues. And we haven’t had a Congress that has been out there to protect the public’s interest around this. And you know, they get a lot of money from the industry, as well. So they formulate their opinions based on how much money they get. And regardless of what they say, we know that the vast majority of legislators that are receiving $50,000 — even $5,000. It doesn’t take much, apparently, to buy off a legislator. They have been extremely solid. They have not protected America’s interests.

Resources Update: Windfall Medicare Profits for Drug Companies

Posted on by Corporations and Health Watch

In January 2006, when the new Medicare Part D drug program went into effect, pharmaceutical companies’ profits were estimated to exceed $2 billion or more annually. The transfer into Medicare of millions of low-income people previously covered under Medicaid provided pharmaceuticals companies with a new source of profit. The Part D proviso that prohibited the federal government from negotiating directly for the lowest available prices further raised profits. In contrast, states have been able to negotiate and receive the lowest available prices for drugs for their Medicaid recipients. However, with the recent elections that gave Democrats control of the Congress, pharmaceutical companies are poised to do battle, as Democrats gear up to eliminate the restriction against the federal government’s ability to negotiate for lowest prices on behalf of Medicare recipients.

Leading Big Pharma’s defense is former Representative Billy Tauzin, who left the House in 2003 after helping to pass the new Medicare Bill to accept an annual salary of more than $2 million as President of the Pharmaceutical Research and Manufacturers of America. Another heavyweight drug lobbyist is Thomas Scully, who served as the Bush Administration’s Medicare expert and helped steer the drug subsidy bill to passage before accepting his lobbyist position in 2003.

GAO Calls for Improvements in FDA Oversight of Direct-to-Consumer Drug Advertising

Tauzin also made the news recently in urging voluntary guidelines for direct-to-consumer (DTC) advertising by the pharmaceutical industry. In a speech to venture capitalists last spring, he observed that, “It would be naive to not acknowledge the fact that D.T.C. advertising is also a lightening-rod in the health care debate in this country.”

Between 1997 and 2005, consumer drug advertising jumped from $1.1 billion a year to $4.2 billion. A recent report to Congress by the Government Accountability Office on FDA oversight of DTC advertising recommended improvements. Congress recently held hearings on the issue. In rejecting Tauzin’s call for voluntary guidelines, Senator Edward Kennedy noted that, “Patients deserve the best and most accurate information about the medicines they take. An essential part of any drug safety proposal must be to give the F.D.A. the authority and resources it needs to oversee direct-to-consumer advertising, and to allow the FDA to impose conditions or limits on that advertising, where needed to protect the public health.”

GAO: Number of New Drugs is Declining

While profits and advertising are up, the number of new drugs is declining, according to another recent report from the U.S. Government Accountability Office. The GAO found that while annual spending for research and development increased by 147 percent, the number of new drug applications grew only by 38 percent. Furthermore, the new applications were for drugs that represented modifications to existing medicines, not new medicines. Such a disparity raises doubts about the pharmaceutical industry claim that rising drug prices are a reflection of new drug development.

Jumpstart Ford

Posted on by Corporations and Health Watch

As part of its mission, Jumpstart Ford works to move the company from its current “worst polluter status” toward acting as a role model in a movement that partners corporations with campaigns and advocacy organizations to achieve a cleaner future for America’s auto manufacturers and consumers.

The campaign’s decision to focus directly on the Ford Corporation rather than on regulatory change follows a trend among environmental and public health advocates, but the campaign is by no means soft in its demands, which include pressuring Ford to produce a fleet of cars and SUVs that average 50 mpg by 2010 and zero emissions by 2020.  In the summer of 2006, the campaign’s website reported new blockades at Ford mega dealerships in Ft. Lauderdale and Los Angeles, as well as the founding of a summer “Freedom from Oil Action camp” which taught new activists the ins and outs of targeting the automobile industry for change in the interest of public and environmental health and safety.  Jumpstart Ford sees America’s oil dependence not only as a threat to human and environmental health, but also as a threat to national security.
During the November 2006 midterm elections, many candidates ran on a platform of lowering America’s dependence on foreign oil, thereby strengthening domestic security.  Given the frequency with which this platform was presented, Jumpstart Ford’s strategy of focusing on public and environmental health, safety and national security, is poised to have more impact on Ford Motor Company’s practices in the near future.

Interview with George Hacker

Posted on by Corporations and Health Watch

George Hacker is the Director of the Alcohol Policies Project at the Center for Science in the Public Interest and a leading advocate in efforts to change health-damaging practices of the alcohol industry. Corporations and Health Watch (CHW) interviewed Hacker in September 2006 to learn more about his work and the lessons he has learned. We were especially interested to learn more about CSPI’s work on Alcopops, sweetened alcohol beverages produced by the alcohol industry to attract young drinkers. The interview was conducted by CHW staffer Estelle Raboni and is excerpted here.


CHW: What is your role at the Alcohol Policies Project and how did you become involved in
this issue?

HACKER: I am Director of the Alcohol Policies Project, and I have been on and off since 1982, for all but five years during that period. I became involved with the Alcohol Policies Project because I was looking for a job at that time, and this seemed to be an excellent opportunity to utilize my skills and interest in public health for a good cause with a good organization. It was also a political environment surrounding alcoholic beverages that was quite in its formative stages. There had been no real effort at the national level at that time to promote a range of prevention policy measures at the federal level that could affect per capita consumption and behavior related to alcohol. And so, for me, it was an interesting opportunity to work with a good organization on an issue which was very important, but also something that provided me with an opportunity to learn and also to create something new.

CHW: So how did you get involved in working on Alcopops?

HACKER: Well, the Alcopops issue came about in a number of ways. Number one, we’ve always been interested in the kinds of products that are put out into the marketplace in the alcoholic beverage market and the basic disregard that producers and government have for the nature of the product and their potential for harm to the public. So when the Alcopops phenomenon began in the late 1990s in Europe and in Australia, we were watching closely. And when they made the leap to the United States, we were eager to highlight the way in which this product was designed and later marketed for young tastes and as an entry level alcoholic beverage that targeted mainly underage people. So those two interests came together and, in addition, at around that time we were approached by a pollster who was interested in doing some work with us, and together we found a donor who was willing to support that effort.

CHW: What was your perception of the impact of the alcohol industry’s and the Alcopops’ impact on human, and particularly pre-adolescent girls’ health at the time?

HACKER: Based on what I had been reading in Europe and in Australia, where these products were being put on the market, I was convinced that by the very fact that they were sweet, packaged to look like soft drinks, and tasted like soft drinks, that they were designed specifically for young people, in particular young women. And so we were concerned that this was just another way for the alcoholic beverage industry to bring consumers not only into the alcoholic beverage market, but also eventually to their standard products. In fact, there were quite a few telling comments by executives in the alcoholic beverage industry that illustrate that that was one of the purposes of these beverages.

CHW: Can you explain more about what you mean by standard products?

HACKER: For example, Smirnoff Ice is an Alcopop, or they call them “alternatives.” Yet it has the name Smirnoff on it, and it intended to highlight that name Smirnoff which also has a wide range of distilled products, namely vodka, in that brand. So, essentially, the Alcopop version is intended to make it easier for people to move up the chain to the original Smirnoff product. And we have a couple of great quotes from the Executive at Sky Vodka who considered Sky Blue’s advertising budget to provide a great benefit to Sky Vodka as well.

CHW: And so that was your initial perception of Alcopops and the alcohol industry?

HACKER: My initial perception in 2000 and 2001, which was based not only on my experience, but on anecdotal evidence and phone calls from people around the country, was that these products very much resembled soft drinks. And they resembled soft drinks both in their packaging and in their flavors and, in particular, their sweetness, and to some extent, the carbonation. So they were really alcoholic copies of beverages that were popular among young people and also common to their tastes. We also got calls from adults around the country saying that they would go out, not knowing that these were alcoholic beverages, and buy them for their teenage children mistakenly because they didn’t look very carefully.

We did a number of photographic comparisons in that we took these Alcopop bottles, and we put them out with bottles of non-alcoholic fruit drinks that were popular at the time. And I think those photographs demonstrated how similar the visual appeal of these products was: bright colors, fancy designs, all kinds of elements of the labels’ bright colors that made them attractive in a way that those fruit juices were attractive. And then later we also compared those bottles to their distilled spirit “parents”, to show how similar — the brand was essentially the same.

Sometimes the same logos were on the labels, and the Alcopops were just a smaller version of the liquor bottle.

CHW: Other than create brand loyalty in future customers through these gateway drinks, how do the actions of Alcopop manufacturers affect human health, particularly young girls and women’s health?

HACKER: Well, by creating gateway drinkers and future drinkers, the primary health impact or risk is that they will be creating people with addictions. Because drinking these kinds of sweet beverages allows consumers to begin drinking at a far earlier age because it meets those sort of teen, preteen taste buds. And the data show that the earlier young people start to drink, the more likely that they’ll go on to have alcohol problems and become alcohol dependent.

Now, we don’t know whether that’s a genetic or environmental effect necessarily, but still there are enough genetically high risk people for whom the ease of drinking could be a significant problem. The other impact is the high calorie nature of these products — they probably contribute to obesity among teenagers. Having said that, I don’t know of any real study that shows that. You know, these products make it much, much easier to drink. It’s more than just a gateway drug. It’s like a worm on a hook.

CHW: We’re also interested in the process of mobilizing communities around alcohol issues. The Alcohol Policies Project has also done some earlier work on Power Master, a new sub-brand of the malt liquor Colt 45 that was targeted at African-Americans. Can you tell me about that?

HACKER: Well, PowerMaster was a malt liquor that was designed essentially for the African American market. First of all it probably violated, at that time, the Bureau of Alcohol, Tobacco and Firearms standards relating to promoting the strength of a product, of a beer, given the name itself of “PowerMaster.” And the African American community took tremendous umbrage at the name which brought back all kinds of connotations of slavery, and the protest against that product was enormously successful, and it took three weeks to get that off the market.

CHW: Does CSPI generally tend to collaborate with communities in order to mobilize against these particular products?

HACKER: Oh, absolutely. Since 1982, we’ve been organizing both long standing and temporary coalitions on a variety of issues; and in addition to issue coalitions, we frequently organize petitions and letters that have multiple signatories that involve various constituencies.

Sometimes we focus just on the faith communities. Sometimes it’s a broad-based coalition that mirrors our Coalition for the Prevention of Alcohol Problems. Sometimes we go to the public health schools, or the Health Department Directors in States, and others like that, to get their support for various activities.

CHW: And so was your organization also part of the attempt to get PowerMaster out of those particular cities?

HACKER: Oh, absolutely. On PowerMaster, we were one of several organizations and, as I recall, for strategic reasons, we had African American organizations take the lead on that campaign, although we were pretty outspoken in the media. We also played a role of providing information and government contacts, and coordination, as well as involved in a number of conversations with people at different organizations who were interested in doing something about it. I think that campaign is an example of how targeted communities as well as the advocate organizations that work on these issues can come together rather rapidly to take on a challenge like that. And just that practice in organizing increases the likelihood that future opportunities don’t go unanswered.

CHW: With Alcopops you’re trying to fight against a product not necessarily directed at a particular race or ethnic group, but toward a particular age group, do you find it’s more difficult to organize against that?

HACKER: Well, you know, when we launched the Alcopops effort it was more a public education effort that was intended to boost interest among policy makers, both on the Hill, as well as in agencies like the Federal Trade Commission. It was also an effort to boost the attention of major organizations that had some interest in alcohol policy matters. And, from that perspective, it was relatively successful in that over the years, the American Medical Association has done a number of studies and releases on the Alcopops issue.

The Pacific Institute on Research and Evaluation has launched a fairly aggressive litigation strategy related to the classification of those beverages as one effort to slow them down.

And there have also been numerous efforts in the states and among state alcohol beverage regulators and some Attorneys General to tighten the regulation of Alcopops. At the Federal level, the interest that we generated led to an appropriations measure that directed the Federal Trade Commission to investigate these products. Not that that investigation really changed much, or came out as we had hoped; but it generated a great deal of activity and interest. And, in fact, it helped coin the term “Alcopops” in this country, which we think is an important frame for that kind of a beverage, rather than “alternatives.”

CHW: But despite some of those strategies, Alcopops are still on the market.

HACKER: They are, but their sales have come down dramatically since 2002 or 2003. And not only have their sales come down, but the number of products in the market place has diminished markedly. Many of the products just disappeared. And I’m not sure if our efforts are responsible, or if it’s just been such a cutthroat competition in that area for a beverage that was always marginal.

CHW: Given the different kinds of strategies that have been used to limit the attractiveness of Alcopops to the market, what strategy or strategies do you think would ultimately be successful in restricting Alcopops’ marketing to youth?

HACKER: Well, I think as has been sought in other countries, raising the taxes on Alcopops would be very effective. In fact, we have tried that — it’s the basis of the PIRE litigation effort.

Because many Alcopops have a significant amount of alcohol that derives from flavoring agents that are distilled spirits rather than from a malt beverage, we’ve been arguing that they ought to be taxed as spirits. Classifying Alcopops as distilled spirits would increase the tax on those products fairly dramatically. So far, though, the regulatory structure has gone the other way — to liberalize the rules for Alcopops. It used to be that if a half a percent or more of the alcohol came from a liquor source, it would have to be taxed as liquor. Now you have to have half of the alcohol from a spirit source to require that it be taxed as a distilled spirit.

CHW: How does the alcohol industry promote Alcopops?

HACKER: At the time we did our first poll, there was no television advertising at all. It was just some print advertising around. What we found in that first poll was that the products were dramatically more popular and more likely to be used by underage persons than by adults so we demonstrated their attractiveness and that many young people said that they had consumed them.

And those findings are now regularly corroborated by the Monitoring The Future Study, which has begun to ask high school students about Alcopops (they call them malt beverages or alternatives) and the Center of Alcohol Marketing Youth also issued some corroborating data that showed that young people were being targeted, or at least they were being exposed to a higher percentage of ads for Alcopops than were adults on a per capita basis. So we were showing what these products looked like, and they looked like soft drinks and they tasted like soft drinks and, indeed, young people seemed to like them. That’s what we were trying to demonstrate the first time when we sent that information to the regulators.

CHW: But despite that, you just mentioned that they’ve actually relaxed some of the regulations on how Alcopops are classified and taxed. So what would be the cause of something like that?

HACKER: I think we made a substantial case that these products seem to be very popular among young kids, and later on we showed that kids have the opportunity and, in fact, they seem to be more exposed to the advertising for these products than adults; that the products themselves seem to be favored by folks who don’t like the taste of alcohol; that people in the industry themselves acknowledge that these are “entry level” drinks; that they bring people to their main brands; and that they are basically “starter suds,” as we call them. We demonstrated all that, I think, but the Federal Trade Commission apparently wasn’t convinced or they just didn’t want to do anything about it.

And then, No. 2, the Bureau of Alcohol, Tobacco, and Firearms, which is now called the Alcohol and Tobacco Tax and Trade Bureau got involved. That’s where the battles among the industries occur. For example, one of the major Alcopop producers, Diageo, which makes Smirnoff Ice and its progeny, does battle there with the beer industry. There was a tremendous political battle going on during the evolution of those Alcopop rules, and I think the Alcohol and Tobacco Bureau just reached a political decision. It was a compromise decision that changed the previous rule to allow these products to have some level of distilled spirits, alcohol, in them.

CHW: One of the strategies I’ve heard is to require alcohol manufacturers to list calorie and ingredient content in Alcopops. Is the thinking behind that that young girls who are the main target of Alcopops would be dissuaded from drinking the beverage once they knew what the calorie content was?

HACKER: That’s one of them. Did you see our advertisements that we ran in several college newspapers? It shows a sort of an androgynous expanding waistline, but it was probably supposed to be female with handle bars and a person pinching the large handle bars. And that was an effort to do two or three things. Number one, we placed those ads, as I recall, at many schools, five or six of the schools that had been named “party schools” in the Princeton Review.

That was about the time when this issue of ingredients and alcohol beverage labeling started to come up again. And we wanted to tie it to that so if you read the copy in that ad, it talks about the fact that people are being confused, or at least they’re not aware of the fact that these products have a ton of calories — sometimes two or three times as much as beer. And as a result young women consuming more calories than they might desire. And so it was an attempt, to open people’s eyes to the fattening nature of these products as one means of decreasing the demand for them, but it was also an effort to strengthen support for labeling requirements that would provide that kind of information for consumers, because it’s currently not required. As you may or may not know, CSPI has been petitioning Federal agencies to require ingredient, calorie, and some other labeling of alcoholic beverages since 1972.

CHW: Why do you think it’s taken this long to have it considered?

HACKER: Well, I think that there are powerful interests that are not particularly interested in providing all that information to consumers. And those interests are usually the alcoholic beverage industry. But having said that, there are three producer industries, all of whom have some slightly different interests when it comes to labeling issues, so they’re fighting it out amongst themselves as well. But also the Alcohol and Tobacco Bureau is in the Department of the Treasury, and I don’t think there’s a great interest in alcohol over at the Treasury, especially in this Administration.

CHW: Is the alcohol beverage industry a powerful lobby?

HACKER: Of course. I mean because it’s a multilayered and multilevel lobby. The producers groups, the distributor groups, the retail groups. Then you have hoteliers, and advertisers, can makers — you know, it’s a tremendous lobby plus wine is produced in California, which has the largest Congressional delegation in Congress. As just an example, wine is produced in 49 states so that there’s a political element in each State. The National Beer Wholesalers is one of three or four top PACS in the United States Congress today, and they have a lot of family and other owned businesses around the country that interact regularly with their members of Congress and other politicians and also provide a lot on money independent of the national group. And you have these big corporations like Anheuser Busch and Diageo and SABMiller, Coors — they exert a lot of influence. The other thing that I think is important to remember, part of the mission of the Alcohol, Tobacco Tax and Trade Bureau is to ensure an orderly and legal system for the production and distribution of alcoholic beverages. And so to some extent, that agency is very used to dealing with the industry as their clients, and they serve, to some extent they service that industry as much as regulate it.

CHW: Do you think that representatives of the alcohol industry feel any pressure in scaling back their marketing attempts as a result of the Project’s work?

HACKER: I think that they have changed their behavior as a result not only of our Project’s work but of the work that our Project has spawned over the last twenty years. The fact is that our Project has led to these broad coalitions, has I think stimulated interest in other organizations to do similar work. It has led groups like, M.A.D.D., Mothers Against Drunk Driving, Community Anti-Drug Coalitions of America, Join Together, the American Medical Association and others to focus on some of these issues. And so, together, we have the capacity to bring these kinds of issues to the public’s attention as well as to the attention of policy makers. Now there are some policy makers now who have articulated an interest in strengthening the regulation of alcohol advertising, for example. I think the industry has been forced to change its practices. The way they’ve done that is they’ve, number one, changed their advertising codes and made them more transparent, they have increased the number of their supposed responsibility messages. Actually, many producers have now added a tiny little line in their ads, something like “Drink responsibly.” We don’t think that’s going very far. But on the other hand, I don’t think they would have done many of the things that they’ve done, as well as they’ve been forced to create a tremendous amount of public relations/public education materials and activities in order to buttress their public standing. So they’re all now engaged in a whole lot of face-saving public relations and supposed responsibility endeavors. But a lot of that is, I think, is just called “CYA.” [Cover Your Ass].

Another result of our and our colleagues’ activities, is that they’ve massively expanded their political contributions and their influence on Congress and state legislatures. But, having said all that, I think that the Alcopops advocacy work gave the industry some headaches because no one in their right mind would believe that those products are not youth-oriented. Yet, those products are still out there. They’re available, because of the way they’re regulated at the State level, in the same places that beer is available making them very available to young people. They’re broadly distributed and not, sort of, holed up in liquor stores which are more restricted, and there are fewer of them than convenience stores for example. It’s somewhat hard to say how successful we’ve been. I think that we’ve been more successful since l982, as I’ve said, in getting the industry to change its behavior. Not that its behavior is so stellar today.

CHW: And finally is there anything else that you’d like to add?

HACKER: Well, let me put the Alcopops into a little perspective. The Alcopops fit in with two issues that we were working on. One of them was sole focus on alcohol and young people given how important that connection is in terms of public health and safety, and also how important that is in the context of the alcoholic beverage market. And we think that the alcohol industry’s Achilles heel is that they rely so heavily on recruiting young people, just as the tobacco people did, in order to create a marketplace for the future. And with regard to younger people, the young people are perhaps the heaviest drinkers around. So they consume a substantial amount of the alcohol and they’re a valuable market in themselves. But then, there were other issues that have been boiling since the mid to late 90s that started to get hot in the early 2000s, and that relates specifically to the advent of distilled spirits advertising on television and radio. And part of the Alcopops effort, particularly when we started focusing on the liquor brand names, was focused on undercutting Diageo’s efforts to get liquor on TV because we were demonstrating how many young people were in the audience and how great their access was to TV, how little they were supervised, and that the proposal that Diageo made at that time to air the ads only after nine o’clock on certain shows was totally inadequate and clearly ignored the large number of young people in the audience. So we were looking at trying to get that message out to poison the waters for the distilled spirits advertising as well.