American pharmaceutical companies have proven successful in a postwar global marketplace, competing in the 1990s with ever-growing multinationals like the Glaxo Welcome/Smith-Kline Beecham merger. Large research investments, generally wellcontrolled testing and aggressive marketing have made American products household names throughout the world. At the same time, continuing price increases have made these companies domestic targets for healthcare reform. They have also raised ethical and political questions when necessary medications are not available to the poor in the US, much less for epidemics like AIDS in the Third World.

Drugs are big business—American companies like E.I. Lilly, Schering Plough, Merck, and PfizerWarner Lambert are among the largest international producers. These companies took to the airwaves in a new way in the late 1990s, with the FCC’s relaxation of a longstanding ban on ads for prescription drugs. Now, $1.3 billion goes annually to sell Claritin, Viagra (with former presidential candidate Bob Dole as spokesman), Zyban, Rogaine and other prescription drugs in addition to Tylenol, Tums and other “over-thecounter” (non-prescription) drugs. In addition, manufacturers also seek to influence opinion leaders among physicians and hospitals. Over forty new prescription drugs enter the market annually, coming from $24 billion in research.

Yet pharmaceutical development also responds to existing markets. Hence, in 1999, 25 percent of new developments were linked to senses and the nervous system, while miniscule research moneys focused on tropical diseases not generally found in the US.

Merck, to give one example, gains more than 30 percent of its sales from drugs whose syndromes can be related to America’s problematic foodways—including cardiac issues, hypertension and high cholesterol. Since these companies are heavily involved in the funding of university research, their interests may influence entire areas of study This disparity in potential consumption creates the specter of so-called orphan diseases, dramatized in Lorenzo’s Oil (1992). Early money for AIDS research also was raised outside of corporate channels.

Consumer resistance to the power of big pharmaceuticals emerges in complaints, through negotiations via insurance and through a turn to generics that do not carry patented prices (although the drug industry fights to modify and repatent drugs so as to avoid generic competition). One might also see resistance in holistic/alternative health.

Yet it is hard to fight an industry that may provide life to a loved one or even oneself.

Drug marketing in the US is controlled through the Food and Drug Administration, which gained fame for its rigor—especially with regards to the thalidomide crisis of the 1960s. Since 1992 the FDA has developed a fast track, demanded by AIDS patients and others looking for rapid drug approval; this twelve-month process demands that pharmaceutical companies pay $200,000 per drug. Monitoring afterwards also remains important—four drugs have been recalled in the last decade, including the diet combination Phen-Fen.