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Chances are, the commercial is familiar, seen more often than not at dinnertime: a middle-aged woman begins a discussion by saying, “I can’t even believe I’m talking about this.”

The “this” in question is her overactive bladder, and the slightly unsettling advertisement is for oxybutinin chloride, better known by its brand name of Ditropan XL. The drug, available only by prescription, is manufactured by Alza, which began promoting it with a print and television campaign in 1999, using a strategy known as direct-to-consumer advertising, which critics contend leads to an overmedicated populace.

The approach’s effectiveness in getting Americans to consider drug therapies is well-documented. A study conducted by researchers at Harvard University and the Massachusetts Institute of Technology found that for every dollar spent on direct-to-consumer advertising, drug sales increased by $4.20. In 2000, that translated to an additional $2.6 billion in pharmaceutical sales.

“By raising awareness of overactive bladder as a treatable medical condition,” Thomas Bruckman, former executive director of a patients’ advocacy organization called the American Foundation for Urologic Disease, said in a press release for Ditropan, “consumer campaigns like this one will help more people seek treatment from a urologist or other physician.”

Bruckman’s praise—cheerfully quoted by Alza in a 1999 press release touting its launch of the media campaign—wasn’t his organization’s only testimonial on behalf of the pharmaceutical industry. AFUD’s mission is to “raise funds for research, lay education and patient advocacy for the prevention, detection, management and cure of urologic disease,” according to its Web site. And over the years, it’s been a reliable supporter of the industry.

AFUD’s blend of patient and drug-maker advocacy is only one example of how, over the years, the pharmaceutical industry has mounted a sophisticated grassroots campaign to build support for its position on key issues that affect its bottom line. The industry has funded various groups to champion its positions, sponsored studies tilted to the industry and hired public relations firms to spearhead campaigns to soften up public opinion and government policies.

According to its annual reports, the Pharmaceutical Research and Manufacturers of America—the main lobbying organization for the industry—organized “more than 800 state and local allies and more than 40 national organizations to support the industry’s federal legislative agenda,” recruited “more than 35 prominent academicians to discuss the vital importance of intellectual property protection in promoting pharmaceutical innovation,” organized “more than 10 issue briefings by research organizations,” and formed “more than 20 state-based patient coalitions.”

PhRMA internal planning documents, obtained in 2003 by the New York Times, detailed budget plans for that fiscal year beginning in July and described a massive grassroots assault, budgeting almost $9.4 million for third party op-eds and articles, Washington, D.C.-area advertising, media relations consultants and other public relations efforts. Other highlighted areas of interest included spending more than $12 million to ally with doctors, patients, universities and minority groups and a minimum $2 million to policy and research groups.

Public image unlimited

Many of the pharmaceutical industry’s biggest names are no strangers to the world of corporate philanthropy. They shower millions on public advocacy non-profit organizations with a variety of missions. Some groups tout the support of pharmaceutical firms. But because these non-profit organizations are under no legal obligation to reveal their donors, they provide the drug industry with another avenue through which it can surreptitiously spread its message. And while some of the groups that the industry funds are independent, many are little more than echo chambers, designed to support positions favorable to the pharmaceutical industry that pays their bills.

The Institute for Policy Innovation, founded by former Republican House Majority Leader Richard Armey in 1987, says its mission is to “develop and promote innovative and non-partisan solutions to today’s public policy problems.” The Texas-based non-profit doesn’t publicly disclose its funders, but according to the Foundation Center, which tracks philanthropy, the Eli Lilly and Company Foundation is among the group’s supporters. The charity is funded by Eli Lilly, and, according to the foundation’s Web site, is “the major source of the company’s financial support for non-profit organizations.”

IPI has published reports opposing drug re-importation and price controls and defending the industry’s lavish spending on advertising, especially the kind of direct-to-consumer advertising also touted by the American Foundation for Urologic Disease. Dr. Merrill Matthews Jr., the IPI expert who authored the drug advertising report, also works as an advisor for the American Legislative Exchange Council, a conservative free-market oriented association of state legislators whose officers and board members include a former lobbyist for PhRMA, Kurt Malmgren, and representatives from Pfizer and GlaxoSmithKline. ALEC has also taken stands against importation and legislative price controls.

Using such nominally non-partisan policy groups is nothing unusual for the industry. The American Prospect reported earlier this year that the Pacific Research Institute, a free-market think tank, receives some of its funding from PhRMA, Pfizer and Lilly. The institute weighed in on a debate in the West Virginia legislature and opposed a bill that would have mandated price controls on prescription drugs, an anathema to the industry.

A visit to the Institute’s Web site reveals that some members of its brain trust moonlight at public relations firms. Peter Pitts, the Institute’s Senior Fellow in Health Care Studies, is also the Senior Vice President of Health Affairs for the public relations firm Manning Selvage and Lee, which lists more than 15 top pharmaceutical companies as clients on its Web site, including Pfizer, GlaxoSmithKline, Lilly and Novartis. Mark Davis, a Senior Fellow in National Issues, is one of several former Republican White House speechwriters working as guns-for-hire with public relations firm the White House Writers Group.

Public relations is the fulcrum that allows the industry to leverage its muscle by launching its own grassroots activities. Pfizer, for example, currently employs the firm Bonner and Associates to promote its Medicare drug discount package. Founded by Jack Bonner, the firm is one of the innovators of grassroots public relations work, and Bonner is widely viewed as a leading purveyor of “Astroturf lobbying,” a term for industry-supported grassroots campaigns.

In 2002, when the Maryland legislature debated legislation that would have capped prices for prescription drugs, a group called the Consumer Alliance faxed petitions to community leaders that warned the poor and disabled were in danger of losing access to affordable prescription drugs. The BaltimoreSun revealed that Consumer Alliance was a front group used by Bonner and Associates on behalf of PhRMA. Some health care advocates filed a complaint with the state ethics commission, charging the deceptive campaign violated Maryland’s state lobbying disclosure law. Ultimately, the complaint was not pursued after Bonner and Associates belatedly registered to lobby with the state.

The year before, Bonner and Associates had teamed up with the 60 Plus Association to run a phone campaign on Pfizer’s behalf that urged Minnesota constituents to oppose state price control legislation, then patched them through to their state legislators.

Time release campaigns

Like many of the vehicles that pharmaceutical interests have made use of, Citizens for Better Medicare, a group that billed itself as a grassroots organization consisting of numerous organizations and more than 300,000 individual members, went out of business shortly after the legislative battle it was created to influence had come to an end. The broad-based group reportedly spent more than $60 million of PhRMA’s money on television and newspaper ads before the passage of the Medicare prescription drug benefit in 2003 rendered it anachronous.

Other groups launched or kept afloat by the pharmaceutical industry have had a longer shelf life. Though Citizens for Better Medicare is defunct, some of its allies, including the Seniors Coalition and the United Seniors Association, are still active. In May 2005, the Seniors Coalition held a press conference in Bismarck to oppose North Dakota Sen. Byron Dorgan’s plan to increase prescription drug importation in order to lower the price of drugs. The United Seniors Association, which ran ads in the last election as early as 2003 supporting industry-friendly candidates, is now backing restructuring of the Social Security system.

Both groups have received substantial support from pharmaceutical interests over the years. The United Seniors Association spent more than $18.5 million on radio and television advertising in 2002 and more than $23 million in 2003, much of it supporting Republican candidates opposed to drug importation or government-mandated price controls. Much of that money came from “educational grants” doled out by PhRMA, including, by the reported admission of United Seniors Association Chairman Charles Jarvis, a large chunk of $12 million spent in 2002.

Mac Haddow, chairman of the policy advisory council for the Seniors Coalition, acknowledged to the Bismarck Tribune receiving educational grant money from drug companies, though he maintained the grants were only a small portion of the group’s total funding.

Take with grains of salt

Many patient and medical groups also use Web sites to draw in potential customers for the pharmaceutical companies’s wares. The address www.sui.comcontains information on SUI, or stress urinary incontinence, which can be treated with drugs. The Web site, which is sponsored by Eli Lilly and Boehringer Ingelheim, links to the National Association for Continence (also an Eli Lilly-Boehringer Ingelheim-sponsored site) and the American Foundation for Urologic Disease. AFUD lists several pharmaceutical interests among its sponsors, including top pharmaceutical companies Merck, Novartis, Boehringer Ingelheim, and AstraZeneca. AFUD is also affiliated with the American Urological Association, a professional organization that receives support from the same companies, as well as Pfizer, Abbott, Sanofi-Aventis and Eli Lilly, and spent $1.5 million lobbying the federal government from 1998-2004. [In fact, in May 2005, AFUD was folded into AUA.]

In December 2002, Anthony Caputi, AFUD’s manager of government relations and patient advocacy, testified before an FDA advisory committee about the benefits of AstraZeneca’s prostate cancer treatment Casodex. Billing the drug as “a good thing for patients,” Caputi praised the drug’s low impact on sexual performance and desire and lack of other side effects. Caputi also told the committee that AstraZeneca had paid for AFUD’s educational programs, for some of his own travel to review data on Casodex, and that he had signed a confidentiality agreement with the company.

Although Caputi is not currently registered to lobby Congress, it hasn’t stopped AFUD from promoting legislation on Capitol Hill. The organization recently engaged in a campaign for passage of the Training and Research in Urology Act, a measure introduced in the last Congress that would have allocated more than $30 million to create a separate division within the National Institutes of Health devoted exclusively to urological research.

A letter on the group’s Web site from Caputi urges “Congress to act now” and praises a “handful of sponsors,” including Rep. Jim Leach, R-Iowa, Rep. Charlie Rangel, D-N.Y. and former Rep. Martin Frost, D-Texas. Despite the Congressional support and its call to action, AFUD, a 501(c)(3) non-profit organization, has declared on its 990s filed with the Internal Revenue Service that it has engaged in no lobbying for the last three years. It is not listed as a registered lobbyist with the Senate Office of Public Records.

Victoria Kreha, Kevin Boettcher and Emily McNeill contributed to this report.

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