Over the course of the last decades the nature of the 'Health System' has strongly changed: from a system focused on 'patient care' to a ‘profit-oriented’ system. Now it is dominated by big pharmaceutical companies whose main objective is to make profits, often to the detriment of the health of citizens, as it has been proved by several publications and investigative programs. What are the causes of this change? What does the statement 'inventors of diseases’ mean? What kind of strategies do pharmaceutical companies use to make countries and citizens buy (often useless) drugs? What are the adverse effects of an abuse of medications? ‘Ebola:’ was the emergency well-addressed? Silvestro Montanaro, journalist, supervisor of the documentary ‘Inventori di Malattie*,’ aired in October 2013 as part of the RAI’s program 'C’era una volta*,' answered to these and other questions. * English Translations: Inventori di Malattie: Inventors of Diseases; C’era una volta: Once Upon a Time.
Silvestro Montanaro: Silvestro Montanaro began his career as a correspondent for the newspapers ‘Paese Sera’ and ‘Unità.’ Then he worked for the newspaper ‘Voce della Campania,’ making sensitive investigations on the relationship between the Mafia, the Camorra and political and economic institutions. In 1989 he made some dossiers on illegal immigration and served as press secretary to the first association of immigrants. In the same year he joined the founding group of the telecast Samarcanda. He worked with Michele Santoro in the TV programs Il Rosso e il Nero and Tempo Reale, becoming the co-author in the last phase. Meanwhile, he published three investigative-books: one of these was made together with Baldini and Castoldi, and adopted as a textbook in many schools; it focuses on the situation in Mozambique after the war. Silvestro Montanaro also supervised the TV program Sciuscià, making some episodes. From 1999 to 2013 he was the author and host of the TV program ‘C’era una volta,’ broadcasted on Italy’s RAI 3.
INTERVIEW- (December 2014)
Oggetto: The pharmaceutical business; What does mean 'inventors of diseases?'; Ebola
Question 1: Good morning Mr. Silvestro Montanaro. On 5 October 2013 you published a documentary, ‘Inventori di Malattie,’ broadcasted on RAI 3 (Italy’s TV broadcaster) as part of the TV program ‘C’era una volta.’ In your premise you said: ‘The patient is no longer considered a man; he is considered a consumer; he is a big business!’ Can you explain us what’s the meaning of this statement? Why have pharmaceutical companies become such a ‘profit-oriented sector?’ What are the consequences?
First of all let’s make clear that ‘Inventori di Malattie’ was the result of a great team work under my supervision. Well, what we wanted to say with this documentary? Our primary message was the following: over the last decades, most human activities have suffered a strong ‘process of financialization.’ Finance, money, profits have penetrated every aspect of our life. Naturally, also the Health System (the system that should take care of our health) has been badly affected by this process. Up to 40-50 years ago, health was considered a 'universal heritage' and the doctor was considered the guardian of this heritage, the person you could trust to preserve your health. Now things have changed: health is no longer the primary concern… ‘Increasing stock market performances’ is the primary objective of big pharmaceutical companies. So it’s not surprising that, by now, in these companies the number of employees in the marketing and finance departments highly exceeds the number of employees in the research department. In other words, ‘selling products’ is more important than ‘developing effective ones.’ Now a new products launch depends more on its potentials to make profits and increase the companies’ stock price, than on its effectiveness on human health. The mission of improving health has been completely replaced by the mission of making profits: in the long run, a listed company with steady-low returns is doomed to fail; it must have increasing-high returns; that means: job cuts, spending cuts (including spending in Research & Development), investments in marketing and bets on marketable and profitable products.
When did this financialization process of the Health System start?
We have to go back in the 80s, at the outbreak of the AIDS epidemic. It not only caused a lot of victims in those times. It was a ‘global’ epidemic thanks to which several pharmaceutical companies made profits and increased exponentially their stock prices. That was a breakpoint, the begin of a catastrophe: since then these companies had to make growing profits to meet the rules of the global financial markets; to this end, they needed some new epidemics to exploit economically; in the absence of natural epidemics, they started to create ‘new epidemics.’
There are many clear examples. Let me mention the event I much investigated on and which has raised a strong sense of anger in me: 'the Avian Flu (1997).' At the time, there was a widespread fear that a new epidemic could hit all us; and millions of bottles of a drug passed off as a vaccine were sold. I’m talking about the 'Tamiflu.' Invented by a small American pharmaceutical company, the commercial rights of this drug were then purchased by a large multinational company; the agreement included big % share on the revenues for the original creator of the drug (the original small pharmaceutical company). To be sure, we are talking about a drug which had already been banned in Japan for its severe side effects: a strong mortality rate among children under eleven years and among the elderly, and many cases of induced mental disorders. Despite all this, this drug has been used as a 'vaccine' for the avian flu! Actually, Tamiflu is not a vaccine for two reasons: 1) it is a useless and dangerous drug (as proved in Japan); 2) as long as there is no transmission of the disease from man to man a drug cannot be marked as a vaccine. To better understand the scope of the 'fraud,' you should know that the avian flu, since its origin, has caused less than a couple of thousands of deaths around the world, less than a normal and common flu alone causes each year in Italy.
However, it’s a question of finance again! With the avian flu, ‘a climate of fear’ was created in order to sell medications passed off as remedies. The sales of the Tamiflu made the big pharmaceutical company duplicate (if not triplicate) its stock values and let the original small pharmaceutical company make a lot of money. The vice-president of this American company was Donald Rumsfeld, a member in the ‘Bush’ administration; that shows the strong connection between the pharmaceutical industry and the political system. In essence, the story of the avian flu and the Tamiflu is a typical example of how an unjustified panic was created to generate a big business.
What I have described above is not limited to the case of Tamiflù. There is now, for example, an awesome global campaign, something that has shocked me: convincing women to get free from the monthly menstrual cycle; a ‘magic pill’ will cancel this ‘natural’ process. Another example? In the United States there are 5-6 million ‘lively children’ deemed as 'mentally disturbed' and forced to take 'psychiatric drugs;' these drugs will cause long-term negative effects on their mental development. Unfortunately, there are several other examples like these.
Question 2: In the documentary, Peter Rost, an American Journalist, former deputy director of Pfizer, says: ‘the pharmaceutical sector is a Mafia-like system.' What does this mean?
The term is very strong… However, it is not completely wrong! There is a system which designs and produces global ‘fear mongering campaigns’ which terrorize people so as to sell goods (sometimes dangerous goods, as in the case of Tamiflu). Isn’t that a Mafia-like organization? I think so! We are talking about a global system which is ‘sick in its soul;’ it’s business-oriented and corrupted to its roots (even general practitioners are affected: many of them get financial rewards when prescribe certain specific drugs). All this is 'illegal' and 'dangerous!'
Question 3: In the documentary you quote the France satire of the 20s: 'Dr. Knock and the triumph of medicine.' Dr. Knock, the titular character is able to use propaganda to convince the town’s people that they are all sick—with the presumption that their fate could be altered by the ‘miracle of science.’ In other words, thanks to a well-planned communication strategy, Dr. Knock is able to sell drugs to healthy people! What’s the current role of ‘communication’ in the pharmaceutical sector?
Perhaps communication now plays the leading role in the strategies of pharmaceutical companies: now, what you ‘say’ to sell is more important of what you ‘really’ sell. And this is particularly true in the Health System. Pushing countries and people to buy a specific drug is primarily a question of communication: communicate that the drug is what they need to solve their problems and face their (often unjustified) fears. In such a way, it is possible to sell ‘ineffective drugs’ to solve ‘inexistent diseases;’ countries and people spend money and the pharmaceutical system makes profits.
And that is not true only for the Health System! We live in an ‘era’ where some advertisers are able to set Hollywood-like scenarios in order to justify certain actions and goals or promote certain products. These are, for example, the communication agencies which spread the Avian flu fear, made us concerned about the production of weapons of mass in Iraq, and have generated much information which then have proved to be real 'hoax;' They are able to mobilize the global population (or most of it) in order to achieve a certain particular (often economic) goal.
So this is the scenery. And what I wonder most is: are politicians doing something? I don’t think so.. this is very dramatic: politicians are nothing but betraying the citizens; in this way, they favor campaigns of global manipulation which benefit few people at the expense of social welfare.
Question 4: According to Lisa Cosgrove, professor of psychology at the Univerisity of Massachuset, Boston, the pharmaceutical company Eli Lilly, when the patent of the antidepressant Prozac was running out, renamed Prozac as Sarafem. Eli Lilly recolored the pill and adopted it for treating another disease: the Premenstrual Dysphoric Disorder (PMDD). In poor words, Eli Lilly created ‘a new disease rather than a new drug.’ Is this a way of inventing diseases?
Absolutely yes! After some years, patents no longer produce much cash. At the same time, the cost of creating and patenting new products are very high. So, why not inventing a new disease? Why not treating that disease with the same product? This is a way of making profits with the minimum effort… create a new disease to treat with the same product! This behavior is socially unfair, but it is economically rewarding...
Question 5: since 1997, in the United States pharmaceutical companies have been allowed to make direct-to-consumer (DTC) advertising for prescription drugs. What role have had advertising and promotional campaigns in the growth of the pharmaceutical companies?
DTC advertising of prescription drugs in the United States is only part of a more general global trend: using promotional campaigns at all levels in order to sell more pharmaceutical products. In many countries we see doctors, communication media and retail chemists literally promote certain drugs and food supplements. This is, in my opinion, one of the most shameful aspects of the business of health. In South America (where I currently live), for example, entering a chemist is like entering a supermarket! There are special offer drugs, and loyalty campaigns.
At all levels of the Health System, the efforts point to increase the sense of ‘fear’ in the patients: people afraid of becoming sick tend to buy more products; they become a big source of money!
Question 6: Alison Bass, in his book ‘Side Effects’ has brought to light the dangers behind an illogical use or abuse of drugs. In your documentary, you mention the case of Paxil, an antidepressant created by the pharmaceutical company GSK to treat the ‘Social Anxiety’ disorder. Its side effects are severe: suicide and drug dependency. Is the profit-oriented pharmaceutical industry damaging health rather than improving it?
There is no doubt that the overuse of drugs causes unpleasant and/or dangerous side effects. Very often these are severe and long-term effects: a weaker immune system, mental disorders, or even death. Many illnesses, especially in Africa, are the result of an illogical use of antibiotics which has weakened the immune system of the people living in this area. Several studies show that the abuse of medications is one of the primary causes of the exponential growth of allergies in developed countries. All this is nothing but the result of the ‘system of fear’ (described above), which, if not addressed soon, will cause a serious human tragedy.
Question 7: Based on the experience you got in this documentary, what do you think about ‘vaccination campaigns?’ Is even there a ’business?’
Yes, it’s not a beautiful thing to say, but also ‘vaccines’ now represent a ‘big business.’ Think of ‘the Tamiflu:’ a drug ‘labeled’ as a vaccine to make profits. To be sure, I strongly think that ‘the vaccine’ is a very important achievement in the human history, a means which has democratized the Health System (witness ‘polio’ which killed many people among the poorest side of society). However, they are mass products; as such, they can be exploited as a source of profits, a potential selling mass market product. That said, how can public health be safeguarded in the future? A critical attitude by patients and institutions is necessary. The role of politicians is essential. They must act in order to protect the health of citizens and the health of their own ‘public finances.’ Spending money for useless or damaging vaccines is no longer a possible alternative!
Question 8: Now Let’s talk about ‘Ebola.’ What do you think about the international efforts made to handle this emergency?
What I wonder is: was there a management of the emergency? An international mobilization? I do not think so! Ebola was initially ignored and left free to grow out. Why? Simply because it is not our problem. It is a problem of marginalized countries!
That said, the situation has been quite dramatic in at least three African countries (Liberia, Sierra Leone and Guinea). And how has the international response been? Miserable! Just read the chronicles of 'Emergency' and 'Doctors Without Borders,' the only international organizations which have worked seriously to face the problem. The situation is quite dramatic: local health structures are fragile and have lost their workforce; without the necessary medical tools, thousands of local health workers have died; there are rows of sick desperate people waiting for a cure from the staff of Emergency and Doctors Without Borders; on the other hand, there are people who stay at home and die because there is no room in the local health structures. In short, the emergency was very-very badly management.
What triggered the spread of the virus?
Talking about the origin of the epidemics is much more complex. First, one has to bear in mind the following fact: when the emergency of Ebola broke out in Sierra Leone, one of the first government’s act was the closure of the laboratory of 'Kenema,' where research on various epidemic viruses were carried out, including Ebola.
Now I wonder: Is it wise to carry out studies on dangerous viruses in such badly organized lab-structures? Could Ebola have escaped from that laboratory? Is that laboratory the origin of the epidemic? I think so! Considering that viruses also escape from high-technological and well-structured laboratories, it is likely that Ebola escaped from the Kenema’s laboratory. But no investigations on this matter have been carried out. In addition, three years ago, some of the research teams working there found medical solutions ready to be tested on humans, but they didn’t get any fund to go on in their research. Why? Whose responsibilities on this issue are? To be sure, I am not a 'conspiracy theorist;' I do not think researchers in those laboratories were creating viruses to wipe out the populations of those poor countries... But I strongly think that there is a lack of information concerning the matter of Ebola. Making the matter more transparent would be very useful to avoid similar dangerous emergencies to happen in the future.
Question 9: Can the medical system regain its values? How? Whose main responsibilities are? Governments? Civil society organizations? Patients? What’s the role of free information (read the Internet) in this challenge?
AnswerOf course! The World Wide Web has a fundamental role to make people more aware of what’s happening, to identify and condemn abuses, distortions and real crimes in the Health System, a system which is currently dominated by money, power and corruption. Health have to regain its original mission: ‘improve the health of patients!’ To this end, civil society organizations, citizens, the free circulation of information, investigative broadcasts have a relevant role. But politics has a relevant role too. The absence of a political will in fighting a corrupted Health System is upsetting and weakens the stability of our society. A profit-oriented Health System is the prerequisite for large disasters; it is a precondition of 'non-health.' 'New warlocks' we’ll see if we don’t act soon... Crimes have been committed and new crimes will be. Have all these crimes been (or will be) condemned? By now, no! We have to work very hard on finding an answer to this question…People need more information; much more transparency, control, accountability and sanctions. Without them, the Health System will never work at the service of public health.