Harvard Doctor Exposes Drug Pricing Hoax

Dr. Richard Burack--the Harvard physician who exposed the drug pricing hoax--is no Ralph Nader. Despite the comparison Sen. Gaylord Nelson (D.-Wisc.) made on the Senate floor two weeks ago, Burack is not a full-fledged muckraker--not yet. He does not want to do battle with the big drug companies; his book does not directly blast them for reaping exorbitant profits on brand name drugs. And Burack tries to be as calm and full of understatement as his book. "My business is education," he says. "I have nothing against these firms; they are trying to make a profit."

But there are signs that now--just three weeks after The Handbook of Prescription Drugs went on sale--Burack is getting impatient with his role as the tolerant doctor. In a rare moment of confidentiality during an interview last week, he leaned over and said, "You know, between you and me, it's silly to pussyfoot around here. I think it's time to clean this thing up right now."

Burack won't have to feel impatient much longer. A Senate investigation into drug pricing will begin next week and Gov. John A. Volpe has already called for one in Masachusetts. And some thing may come out of these hearings, something more productive than the Kefauver investigations on monopoly drug pricing, because now for the first time, everyone will know that brand name drugs cost two to twenty times as much as their generic equivalent. Burack's book will at last let the public in on what pharmacists and many physicians have known for years.

"It's in the Book"

In an interview Burack says very little that isn't in the Handbook. And he doesn't have to. "It's all in the book," he says, waving around the little blue paperback like a fundamentalist minister displaying his Bible. The bulk of the book is an 85-page series of lists of basic prescription drugs--what they do and how much they cost--with comparative prices of brand name drugs and their generic equivalents.

When a drug first goes on the market it has two names--a generic or official chemical name and a brand name for merchandising purposes. Nembutal, for example, is a well-known sleeping pill made by Abbott Laboratories. Nembutol is its brand name; Sodium pentobarbital, its generic name. Under patent laws Abbott had exclusive rights to the manufacture and sale of Nembutol for 17 years. During that time it could charge whatever the traffic would bear since there was no competition. Abbott also sent out detail men--salesmen that all drug companies hire to promote their brands. "They wait around the teaching hospitals especially," Burack says, but detail men visit doctors too. The average physician receives one a week, touting the latest cures and "keeping them up to date," Burack says.

Another way to keep doctors up to date is the Physicians' Desk Reference (PDR), which looks very official. But, as Burack points out, PDR is an advertising vehicle--a fact most physicians don't know. The 1966 rate was $115 per column inch, so the gross value of the space that year was over $1,725,000. Nembutol is listed there, like the other brand names, and Abbott paid well for the privilege. In his book, Burack calls PDR "probably the shrewdest and most effective means by which the pharmaceutical corporations perpetuate their hold over doctors and patients."

Whopping Profits

After the 17 years were up Abbott could keep its brand name and go on advertising in medical journals and in PDR, but now other companies can sell sodium pentobarbital too. Still, during those 17 years of monopoly power, Abbott was able to fix the name Nembutol very well in the heads of doctors and patients. Patients still ask for it and doctors prescribe it. Who would ask his doctor for sodium pentobarbital, even though it's the same thing chemically? That is the evidence of how well the public is propagandized by the drug concerns, which spend $600 million a year on advertising and who reap a whopping 18 per cent profit annually (more than any other industry according to Fortune).

Because of the demand, Abbott charges $16.20 per 1000 capsules wholesale for Nembutol. In his book, Burack lists 15 other reliable companies that make the generic equiva- lent--all but one of them for less than half the price, seven of them for less than one-third the price and one for just $3.95.

Most druggists do not carry these generic equivalents. As a pharmacist in the Square said, "No one asks for them. So why should we stock them?" But the generics can be bought, mainly at larger drug stores in Boston.

Nembuol is really a moderate example of these price inequities. Medicate. a brand name adrenal steroid, sells for $170.00 per 1000, yet a generic equivalent can be bought from any of 12 reliable companies for less than $12.00. One of them sells it for $7.95. Peptids are potassium penicillin G tablets sold by Squibb for $6.72 per 100. but 17 firms sell pen G for $2.00 or less. And that is one generic equivalent that most druggists stock. Colace, an anti-constipation drug made by Mead Johnson, sells for $45.79 per 1000. But eight firms sell the generic, dioctyl sodium sulfosuccinate, for $9.00 or less--one of them for $5.95 and another for $6.00.

Nothing New

What Burack is saying is nothing new. That is how the doctors and pharmacists just shrug off his book. But Random House is certain that the Handbook will be a bestseller. For the first time millions of people will have the information at hand, and even if Senate and state investigations accomplish nothing, there will be public pressure. and that is what Burack wants. In Chicago, Washington, and New York bookstores are already running out of copies. And the Coop says they are selling "exceptionally well." Things are moving fast, "and the real promotion has not begun yet," Burack says with a grin.

Burack is a promo man's dream. He is tan and handsome with a rich radio voice that reeks controlled confidence, like your family doctor's when he tells you, "It's just a virus that's going around." But Burack is not like your family doctor at all. He is a rebel, and even though he would publicly disown the label, it is pretty clear that Burack enjoys taking on an inequity that has been tolerated for decades.

What he does not seem to enjoy are the rounds of public relations activities he must perform. When I spoke with him last week he had just finished a Boston talk show a few days before and a New York talk show the night before. He was just finishing up a speech he would give two days later to a consumers' group. And he had to interrupt our interview for ten minutes to tape a segment for a New York radio station.

The doctor is not used to all this. He spends three hours a day taking blood samples and looking at red throats in his tiny office in the tiny dispensary at the Business School. Four years ago, Burack stopped teaching pharmacology at the Med School and set up a private practice, which he still has in addition to his UHS duties ("and it's suffering," he says).

Dirty Looks

When he started his practice he had no idea that brand name drugs cost so much more than generics or that there was politics involved in the mess. He prescribed generics almost exclusively, simply because those were the names he knew, being a pharmacology instructor.

"I was getting a lot of dirty looks," he said, "from druggists and from my colleagues, and I couldn't understand it. Then one day a pharmacist called me up and asked me to be his personal physician. 'You're the only doctor who prescribes generics. so you must really know something,' he told me. Then I found out about the tremendous price differences. I really had not known until then. What I wanted to do first was just to make up mimeographed sheets of price differences and distribute them to the teaching hospitals."

The more Burack looked into it, the bigger the business became. He wanted to publish an article in one of the medical journals but "a senior Harvard physician" warned him that he would antagonize his colleagues and probably never get it published any-