We'll need government financed incentives to push pharmaceutical companies into developing new antibiotics. Just when we need Pharma to clean up its act and improve its image with the public, we have more unflattering news about the industry.

5,600 women have filed a class action suit against the multinational drug firm Novartis, claiming $200 million in damages. The women claim that Novartis discouraged pregnancies and ignored their complaints of sexual harassment.

Plaintiffs plan to tell the jury that they were denied promotions if they became pregnant or if they took their full maternity leave. One of the plaintiffs was "urged to have an abortion." Another was asked to give the company "two child-free years."

Last week it looked like Big Pharma had won the latest skirmish over importing low cost drugs from Canada and other countries. But the battle isn't over yet. As FiercePharma told its drug company readers today: "And you thought you could stop worrying about re-importation."

Senator Dorgan's amendment to the health care reform bill went down to defeat on Tuesday, but on Sunday David Axelrod, senior political advisor to President Obama, told CNN that "the president is committed to moving forward" on this issue. "Let me be clear," he said. "The president supports re-importation ... safe re-importation of drugs into this country. ... There's no reason why Americans should pay a premium for the pharmaceuticals that other people in other countries pay less for."

Prescription drugs are much more expensive in the US than they are in other countries. Americans pay 36 percent more than Canadians, on average. We pay 39 percent more than Europeans and 43 percent more than the Japanese. Mevacor, a commonly prescribed statin for lowering cholesterol, costs $200 for 100 pills in the US. In Mexico, the cost is $8-$10. By charging US customers the highest price the market will bear, the US subsidizes the low cost of drugs in other countries.

At least once a year, some brave Senator proposes an amendment that would allow Americans to buy prescription drugs from other countries. Spokesmen for pharmaceutical companies, such as Glaxo and Merck, readily admit that the drugs they manufacture and sell in the US are the same as those they sell outside the US. Whenever the issue of importing drugs comes up, however, they cry: "Imported drugs aren't safe! We have to protect the public!"

Do you research medical information on the Internet? Do you use Google as your starting point? Do you read entries on medical conditions at Wikipedia and assume what you read is accurate and complete?

Kevin Pho, primary care physician and author of the popular medical blog KevinMD.com, has a column in USA Today on the use of Wikipedia by patients and doctors:

"I researched my condition on Wikipedia." That's what more doctors, myself included, are hearing from patients every day.

One reason online medical research leads to Wikipedia is that two-thirds of health inquiries start with a search engine, such as Google. Wikipedia entries appear near the top of search results. Are patients influenced by what they find? Half of those who did Internet research say it made a difference in how they took care of themselves or someone else.

Pharmaceutical companies caught in the act

Wikipedia is a great resource, and its popularity and success are well-deserved. However, its entries can be manipulated by anyone who values their own profit or reputation more than accuracy.

When a government is directly involved in health care, the sheer size of its purchasing power allows it to negotiate lower prices for drugs. That's why drugs cost less in Canada over the Internet.

In the US, drug company lobbying is so powerful that it can convince Congress to prohibit the negotiation of discounts (the 2003 Medicare Prescription Drug Act). As if that weren't enough, it's illegal for Americans to order drugs from Canada. (You're allowed to carry a 90-day supply over the border.)

President Obama has, in the past, favored changing legislation that prohibits drug purchases from Canada. (Congress calls this drug reimportation.) John McCain was in favor of change. (It's a popular position when running for election.) Democrats have been advocating this change for years. Between 70 and 80 percent of Americans favor this option.

President-elect Obama has made it clear he wants to change US health policy, and he appears to have widespread public support to do just that. The pharmaceutical industry, on the other hand, likes things just the way they are. We can expect Big Pharma to put up a fight to protect their interests and, in fact, the first shot will be fired this week. But the pharmas need to walk a fine line. Their public relations efforts over the past few years have been an attempt to win public sympathy. Now they need to attack Obama without jeopardizing all that goodwill.

One change in health policy already singled out by Obama is the federal government's ability to negotiate Medicare drug prices. This particular item could cost the drug industry as much as $30 billion. Not surprisingly, PhRMA, the largest pharmaceutical lobbying group, has been preparing for this moment and last week announced a new public relations campaign.

"We're going to do an ad campaign that is designed to make people aware of the importance of preserving your free-market health care system." This from Ken Johnson, a senior VP at PhRMA, quoted in the Washington Times.

In a post titled "Is big pharma preparing to shoot itself in the foot?", David Williams had this to say:

[The PhRMA ad campaign] may try to have the same impact as the famous Harry and Louise ads of 1993 that undermined the planned Hillary Clinton-led reform bill. ... If that's really the aim, someone is misjudging the mood of the public. People aren't looking for "free-market" anything at the moment, especially when what the pharmaceutical industry really means by "free market" is pricing freedom for themselves. ... Here's some friendly advice to the pharmaceutical industry: don't make the mistake of attacking the policies of our new President. Such a move is likely to backfire.

PhRMA polishes its image

PhRMA hasn't been sitting on the sidelines during the election campaign, waiting to see who wins. PhRMA's Johnson also had this to say:

Medicalization and disease mongering

I don't have a lot of personal complaints about medicalization. As a woman, I don't worry about erectile dysfunction or male pattern baldness. I haven't had to decide to use Ritalin for a hyperactive child or growth hormones for a son who is shorter than his classmates. In my heart of hearts, I consider myself a social deviant (and am proud of it), but I don't exhibit behavior that brings me to the attention of physicians, psychiatrists, or the law.

Many things that used to be considered a normal part of life - childbirth, menopause, insomnia, sadness, excess weight, aging, death - have been redefined as medical conditions and subjected to diagnosis and treatment. This process is called medicalization: Redefining a non-medical condition as a medical one. Medicalization is a major contributor to the health culture. It broadens the definition of health and encourages us to think of ourselves as in need of medical attention.

The active process of converting a benign condition into a medical disease is called disease mongering. Lynn Payer wrote a whole book on the subject: "[D]isease mongering - trying to convince essentially well people that they are sick, or slightly sick people that they are very ill - is big business. For people to use a diagnostic product or service, they must be convinced that they MAY BE sick. And to market drugs to the widest possible audience, pharmaceutical companies must convince people - or their physicians - that they ARE sick."