LES 5 MÉTHODES DE L’INDUSTRIE PHARMACEUTIQUE POUR NOUS BOURRER DE MÉDICAMENTS INUTILES

L’industrie pharmaceutique va bien, très bien même. Grâce aux Français, leurs plus fidèles clients au monde, mais d’abord grâce à un intense et efficace travail de l’ombre auprès des autorités politiques et sanitaires et des médecins. Si la santé des laboratoires est renforcée par ces pratiques, ce n’est pas le cas de celle des patients.

Au concours des consommateurs du comprimé, les Français figurent toujours sur la première marche du podium. En moyenne : quatre comprimés avalés par jour pour l’ensemble de la population et une facture de 34 milliards d’euros en 2014. Soit 2,7% de plus que l’année précédente, dont 20 milliards pris en charge par la Caisse nationale d’assurance maladie. Parallèlement, l’industrie pharmaceutique s’affirme comme la plus rentable au monde et elle ne cesse de progresser : 639 milliards d’euros de chiffres d’affaires global pour le secteur en 2013, en croissance de 4,5% par rapport à 2012. Il y a 10 ans, un rapport de la Chambre des Communes anglaises sur l’industrie pharmaceutique concluait : «Elle est maintenant hors de tout contrôle. Ses tentacules s’infiltrent à tous les niveaux» (texte en bas de cet article). Le constat est-il toujours d’actualité? Comment s’y prend-elle, dans quelles strates se fond-elle pour maintenir notre dépendance et commercialiser toujours plus de nouvelles molécules ?

Tout commence par le cabinet du médecin traitant : le principe concurrentiel de la médecine libérale et payée à l’acte implique la notion de satisfaction. Claude Malhuret, sénateur UMP, a proposé plusieurs amendements en faveur de l’indépendance du corps médical face au lobby pharmaceutique lors du vote de la loi santé. «Les médecins sont prêts à tout pour garder leurs patients. Alors ils répondent à leurs demandes. Les somnifères, les benzodiazépines[anxiolytiques]… C’est un scandale, ça tue les vieux! C’est normal, quand on est vieux, de ne dormir que cinq heures par nuit. Tous ceux qui en prennent à long terme – pas plus de six semaines normalement – sont finalement dépendants et subissent un déficit cognitif d’autant plus fort qu’ils sont âgés.» Dans ce système régi par la rentabilité et la réponse aux besoins immédiats du patient, pas le temps de s’intéresser en profondeur aux origines des troubles du sommeil ou d’une dépression, comme l’explique Jean-Sébastien Borde, président du Formindep, collectif de médecins qui œuvre pour une formation indépendante. «Nous sommes parmi les champions du monde de la consommation des anxiolytiques. Or l’accompagnement de ces pathologies prend du temps si l’on veut comprendre ce qu’il se passe, tandis que la prise d’un médicament va soulager automatiquement. C’est la conjonction d’un manque de praticiens et d’un nombre de consultations très élevé pour chacun qui conduit à ces prescriptions très importantes.»

 1. Manipuler le baromètre thérapeutique

Cette surconsommation de médicaments est encouragée par les labos. Première technique : modifier le seuil à partir duquel le médecin doit prescrire. Prenons l’exemple de l’hypertension, à l’origine de troubles cardiovasculaires, qui représente la moitié du marché médicamenteux de la cardiologie, selon Philippe Even, ex-président de l’institut Necker [1]et fervent militant anticorruption. «L’industrie, puis les agences de santé et les médecins ont redéfini l’hypertension à 14, contre 16 auparavant. Alors que la tension moyenne de la population se situe aux alentours de 13. Ça a l’air de rien comme ça, je n’arrive pas à réveiller les gens à ce sujet, mais qu’est-ce que cela signifie?» Le professeur émet un bref silence avant de hausser le ton. «Cela veut dire quadrupler le marché des antihypertenseurs, parce qu’il y a quatre fois plus de gens qui ont une tension entre 14 et 16!»

2. À nouvelles maladies, nouveaux marchés

Autre tendance, la transformation de facteurs de risque en maladies. Exemple phare : le cholestérol, « notre ennemi à tous ». Parmi les traitements « blockbusters », le Crestor, du laboratoire Astrazeneca. Il est la troisième référence pharmaceutique la plus commercialisée au monde. Cette pilule anticholestérol fait partie de la famille des statines, prescrites à outrance et souvent à vie. « Cinq millions de gens sont traités avec des statines en France, explique Claude Malhuret. Contre un million seulement qui en auraient besoin. » Seules les personnes qui ont déjà eu un accident cardiovasculaire devraient en consommer, selon lui. Quid des quatre millions de personnes qui en prennent inutilement ? Les effets secondaires recensés sont lourds : insuffisance rénale, troubles musculaires, cognitifs, hépatiques, impuissance, myopathie, cataractes. Le sénateur enchérit : « Le jour où toutes ces personnes âgées qui consomment des statines et autres somnifères vont mourir d’un accident médicamenteux, personne ne va s’en occuper ou bien même s’en soucier. Elles seront mortes de vieillesse, comme tout le monde ! » 20.000 accidents dus à de mauvaises prescriptions sont recensés chaque année en France. Un chiffre sous-estimé selon Michèle Rivasi, députée européenne EELV, « du fait des carences de notre système de pharmacovigilance ».

3. Chers visiteurs médicaux

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Une vigilance qui doit s’opposer à l’omniprésence du marketing. Les médecins sont quotidiennement sollicités par les visiteurs médicaux qui assurent la promotion des nouvelles molécules. « Les lobbies sont omniprésents dans les couloirs des hôpitaux, affirme Jean-Sébastien Borde, du Formindep. Or, le médicament prescrit par le spécialiste aura tendance ensuite à être prescrit par le généraliste à la sortie de l’hôpital. » Et cette promotion fonctionne à merveille, selon une étude de 2013 publiée dans Prescrire, la seule revue médicale indépendante en France. Les médecins qui reçoivent le plus de consultants ont les ordonnances les plus généreuses. Ces mêmes praticiens reçoivent plus de patients, pour des temps de consultation plus courts et lisent davantage de presse gratuite financée par les firmes elles-mêmes. Les visiteurs tentent d’instaurer« une relation amicale » avec les médecins et offrent petits-déjeuners ou déjeuners, proposent d’organiser le pot de départ des internes… 244.572.645 € : voici le montant total des cadeaux des firmes pharmaceutiques aux médecins entre janvier 2012 et juin 2014, recensés par le collectif Regards citoyens.

4. Séduire les leaders d’opinion

Les Key Opinion Leaders, alias KOL, ou leaders d’opinion, clés de voûte de la promotion des médicaments, interviennent en première ligne, avant et après l’autorisation de mise sur le marché (AMM) des médicaments. Ils sont rémunérés pour réaliser les essais cliniques, les valider puis prêcher la bonne parole durant les congrès de spécialistes, dont les déplacements, frais de bouche et hôtels sont pris en charge par les labos, pour eux comme pour leurs confrères présents sur place. En tant que chef du service de gériatrie à l’hôpital Pompidou, à Paris, Olivier Saint-Jean a le profil parfait. « Je suis un KOL négatif », affirme-t-il pourtant. Le professeur refuse de prescrire les seuls traitements « inutiles voire dangereux » qui existent aujourd’hui contre la maladie d’Alzheimer. « C’est complexe pour nous de dire : “Je n’ai rien à vous prescrire.” Mais à partir du moment où je me suis rendu compte que le traitement était dangereux pour les patients, j’ai basculé et j’ai dit à mes étudiants à l’université que cela ne marche pas. » En 2006, l’Inserm lui demande d’étudier de plus près les analyses de ces médicaments. Résultat : il démontre leur inutilité, et révèle qu’ils peuvent s’avérer toxiques pour des patients justement atteints de troubles de la mémoire. « Je me suis fait insulter par mes confrères, raconte-t-il. Certains, en lien avec les labos, disaient qu’il était criminel de dire que ces médicaments étaient inefficaces. » KOL négatif, donc non rentable, brebis égarée d’un star système qu’il décrit par ailleurs pour y avoir participé quand la recherche était encore teintée d’espoir.

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« Il y a trente ans, ces personnes âgées restaient dans les hospices et les fonds de salle des hôpitaux psychiatriques. Puis, les labos ont proposé des médicaments en parallèle de professionnels qui se bougeaient pour avoir une vraie reconnaissance de ces malades. J’ai eu des liens d’intérêts avec les labos à ce moment-là. On avait vraiment envie de faire mieux. Cela m’arrivait d’aller faire des formations à des médecins traitants et puis, c’est vrai que je repartais avec un chèque. Parfois réinjecté dans le service, parfois dans ma poche. » À l’heure où le montant des crédits alloués à la recherche ne cesse de baisser, de plus en plus de chefs de service, les« patrons », comme on les appelle, acceptent la manne des études diligentées par les labos.

Mais alors quelle différence y a t-il entre lien et conflit d’intérêts ? Claude Malhuret s’est battu au Sénat en 2015 lors du vote de la loi santé de Marisol Touraine pour imposer des amendements en faveur de plus de transparence entre les firmes et le corps médical. « Un laboratoire vous demande par exemple d’effectuer des recherches pour approfondir la compétence sur une pathologie. Vous réalisez cette étude, vous amenez donc des résultats et êtes rémunéré pour les services que vous avez rendus au laboratoire mais vous n’êtes pas en situation de conflit. Au contraire, il y a conflit d’intérêts lorsque, en échange d’une rémunération, vous apposez votre signature en bas d’une étude que vous n’avez pas pris le temps de suivre, de réaliser vous-même. » Ceux-ci sont une minorité insiste Philippe Even dans son dernier ouvrage Corruptions et crédulité en médecine : il identifie par exemple « les six cardiologues parisiens les plus liés à l’industrie ». Ce sont eux qui agissent ensuite auprès des autorités publiques, puis qui deviennent membres et présidents des agences de santé et livrent leurs recommandations au ministère pour les autorisations de mise sur le marché (AMM).

5. Contrôler les études et les consciences

Une fois l’AMM obtenue, une grosse machine en trois étapes se met en branle. La première est celle de la diffusion orale : « Il faut que des universitaires aillent de congrès en séminaires répandre la vérité sur la dernière merveille du monde qui vient d’arriver », raconte Philippe Even. Aux États-Unis, des médecins que l’on appelle les « Tour Doctors » passent des contrats d’orateurs avec les firmes.

C’est à ce moment-là que la presse s’en empare, c’est la deuxième phase. Les firmes s’arrangent alors pour faire signer les articles par les spécialistes des pays au plus fort potentiel de marché : États-Unis, Europe, Japon, Chine, Brésil. « Le plus souvent, ils lisent l’article écrit par des sous-traitants de l’industrie et le signent », poursuit l’auteur de Corruption et crédulité en médecine. Nos consultants ou leaders d’opinion ont ensuite la charge de répercuter la promotion dans leurs pays respectifs, dans les journaux locaux, sur les plateaux télé. « Et alors de nombreux journaux, même réputés, tombent dans le panneau : “Un expert mondialement reconnu”, lit-on dans Le Monde ou dans Le Figaro, par exemple… Reconnu à l’intérieur du périph, oui ! » rit Philippe Even, avant de poursuivre. « Or, ces journaux, comme les journaux spécialisés ne vivent plus que grâce à la pub et donc à l’industrie. » D’ailleurs, quel secteur se porte encore mieux que l’industrie pharmaceutique ? Justement celui de ces journaux médicaux. « Alors que les firmes pharmaceutiques réalisent en moyenne 20 % de bénéfices par an, les organes de publication en réalisent 30 % ! » affirme le président de l’institut Necker.

Dernière phase : le médicament doit être recommandé par les prescripteurs et les sociétés dites savantes, comme les fédérations de santé, qui sont des centaines en France. La fédération de cardiologie par exemple, celle de l’hypertension, la société d’athérosclérose, etc., financées par les laboratoires : « Elles émettent des recommandations officieuses. Pour les rendre officielles, la Haute Autorité de santé reprend les articles d’experts qui les ont rédigés pour les firmes. À travers ces trois étapes, les congrès, les journaux, les sociétés et agences de santé, on peut dire que les sociétés tiennent directement la plume des prescripteurs. »

Sur les 2.000 médicaments commercialisés (10.000 au total avec les copies), seuls « 200 sont utiles », selon Philippe Even. Michel Thomas, professeur en médecine interne [2] à Bobigny, va plus loin. Il a publié une étude en 2013 recensant 100 médicaments vraiment indispensables. « On considérait qu’il y avait beaucoup trop de consommation de médicaments en France et qu’il fallait se pencher sur l’essentiel. »

 

Source: reporterre

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