The afternoon of Nov. 15, representatives of drug companies and their California trade associations gathered in City Hall's Room 278 to stare down a handful of local government officials. On speakerphone, meanwhile, was a lobbyist from the Pharmaceutical Research and Manufacturers of America. PhRMA, as it's known, is the lobbying juggernaut credited with keeping medicine cost-control out of President Barack Obama's healthcare reform package.
These drug-industry white shoes hadn't descended on San Francisco for anything so dramatic as that. They gathered to beat back minor local legislation, sponsored by Supervisor Ross Mirkarimi, designed to make sure unused medicines don't poison kids, contaminate water, or end up scavenged and resold on the street. It would have drugs companies pay a relative pittance to make it easier for consumers to dispose of unused medications.
Notwithstanding, drug companies are fighting this innocuous-seeming bill. Genentech, a subsidiary of the Swiss company F. Hoffmann–La Roche even issued a veiled threat to pull investment from San Francisco, were the bill to pass. That's huge, coming from a company with 1,500 employees living in the city, and millions of dollars' worth of drug development deals with UCSF and local biotech companies.
"The impact of this bill would be to discourage investment of this kind by imposing an impractical burden on Genentech and its peers in the biotech industry," wrote state government affairs manager Steve Hanson, who did not respond to requests for comment.
Why is the drug industry lining up to kill this flea of a bill with a lobbying sledgehammer?
You might feel a little arrogant after muscling your way out of Obamacare. But while rising to become a beat-all bully is a great American industrial tradition, so is stumbling back to earth. Big Tobacco once spent fortunes flattening the tiniest insinuation linking cigarettes to cancer. The oil and financial services industries proudly argued that nonexistent regulation was good for America. But things can quickly change. And Big Pharma's hubris, demonstrated by its all-out effort to staunch a tiny San Francisco drug giveback program, could presage a fall.
Our Board of Supervisors should give drug companies an extra push over the ledge by approving Mirkarimi's bill.
Drug companies have been on their own version of a winning streak, bribing physicians to overprescribe drugs, fabricating efficacy studies, hiding dangers of drugs such as painkiller Vioxx, and stopping reforms that might make drugs cheaper, safer, and more effective. They've gotten rich. But they've also sickened the good name of the pharmaceutical industry. When the equivalent of a BP or AIG scandal hits, drug companies will have no public goodwill to fall back on.
"I think we're seeing a lot of change in terms of confidence," says UCSF medical historian Elizabeth Siegel Watkins, who studies the pharmaceutical industry. In a 1997 Harris poll, 60 percent of those surveyed said drug companies did a good job serving consumers. In 2008, that percentage had fallen to 15 percent.
What makes these figures remarkable is that Big Pharma is no death merchant like Big Tobacco; the industry has the potential to be perceived as a genuine hero. Drugs have eradicated polio, beat bacterial infection, and greatly extended the lives of people with HIV. But lately, innovation has often meant altering old drugs slightly, slapping on a new label, and then raising the price. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, wrote in a 2004 New York Review of Books article that drug prices had been rising 12 percent per year. And in 2002 the average annual price of the 50 drugs most used by seniors was nearly $1,500.
"If I could have a list of people I don't trust, at the top would be bankers and pharmaceutical companies," says Minnesota Rep. Paul Gardener. Earlier this year, he was on the receiving end of a drug-industry campaign to defeat a drugs-return bill he sponsored, which was similar to the one introduced Oct. 26 in San Francisco. In March, the Minnesota House of Representatives passed a watered-down version that excised the part where drug companies would pay to take back their unused wares.
"They jetted in people from Washington who just said, 'Boy, this is going to be a huge cost, and it will cut into our profit margins,'" he recalls.
In San Francisco, pharmaceutical firms and trade associations have written to City Hall warning of excessive costs that would be passed on to consumers. Industry lobbyists did not return my calls requesting comment by press time.
However, Ginette Vanasse, the director of a British Columbia program that is the model for the S.F. proposal, said costs haven't been a significant issue in Canada. "It's not an expensive program, as far as I'm concerned," she says. For the 4.5 million people of that Canadian province, it costs less than $500,000 a year to place special secured bins in drugstores and then safely dispose of the old drugs.
Mirkarimi said the Nov. 15 meeting resulted in an offer by the pharma lobbyists to pitch in for a $100,000 one-year pilot project in lieu of a permanent program fully funded by companies. Startup costs would exceed that sum, though he wasn't sure by how much.
"They're acting like I should think of their offer as Christmas come early," he said, adding that if the lobbyists don't agree to funding a drug-return program, he'll attempt to gather enough votes for a veto-proof board majority.
Returning old drugs may seem like a trivial issue. But it's important to environmental groups such as the Sierra Club, because many flushed medicines can't be filtered from the water supply. Drugs tend to leach through landfills, possibly into groundwater. If expired drugs simply pile up in medicine cabinets, as is often the case, kids can get them.
Mayor Gavin Newsom has endorsed the concept of "extended producer responsibility," the notion that manufacturers need to take cradle-to-grave responsibility for products that end up as toxic garbage. But Mirkarimi said Newsom's staffers told him the mayor would veto the drug-return bill. Newsom spokesman Tony Winnicker did not return a call requesting comment by press time.
Before Newsom starts his new job as lieutenant governor, he could leave San Francisco with a legacy as a politician who stood up to Big Pharma.
"They're bringing their blazing corporate guns and lobbying tactics on to little old San Francisco, just as they've done in other states, all because we're asking them to help pay for a bucket with a lid that's regulated, so that people can properly dispose of their pharmaceuticals," Mirkarimi says. "If that's such a big threat to them, then their arrogance speaks for itself."