ALL THE WRONG ENEMIES

You have to read to the fourteenth paragraph of a story in today's New York Times to get some details of how Forest Laboratories marketed a multi-billion-dollar drug called Lexapro, which has never been demonstrated to be any improvement over its close chemical cousin Celexa, but is (unlike Celexa) still patented, and thus much more lucrative. The details come from an internal company memo made public by the Senate Special Committee on Aging:

Forest's 2004 plan for marketing Lexapro offers detailed information about how the company planned to direct this money to doctors.

Under "Rep Promotional Programs," the document said the company planned to spend $34.7 million to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers in one year.

"These meetings may be large-scale dinner programs with a slide presentation, small roundtable discussions or one-on-one advocate lunches," the document states.

Under "Lunch and Learns," the company intended to spend $36 million providing lunch to doctors in their offices. "Providing lunch for a physician creates an extended amount of selling time for representatives," the document states.

An entire section of the marketing plan, titled "Continuing Medical Education," outlines how the company intended to use educational seminars for doctors to teach them about Lexapro.

Your premium and co-pay dollars at work.

Forest is using money it makes from you to persuade doctors to take even more money from you by prescribing a drug that's no better than much cheaper drugs:

Lexapro had $2.3 billion in sales in 2008 even though generic versions of Celexa and every other drug in the class sell for a fraction of Lexapro's price. For example, a month's supply of 5-milligram tablets of Lexapro costs $87.99 at drugstore.com, compared to $14.99 for a month's supply of a generic version of Prozac.

This is the kind of thing that should be the focus of all discussions of cost savings from health care reform, not "death panels." This is the kind of thing we should be talking about when we discuss comparative effectiveness research, not some wild notion that the government is going to force doctors to prescribe pills that don't do the job rather than treatments that do.

But instead, I found these documents excerpts buried on page B4 of the print Times, more than a dozen paragraphs into the story.

Yes, I know: No one's seriously going after the drug companies because the Obama administration cut a deal with Big Pharma in exchange for some backup on reform (which, by the way, doesn't seem to have stopped a pharmaceutical-industry-based group called 60 Plus from producing ads and other propaganda in opposition to reform).

But a further problem is that, in the general public, the spending in the health care system that does nothing to improve Americans' health but does an excellent job of lining industry bigwigs' pockets just doesn't get enough people angry -- certainly not the way wild rumors about the fascist/socialist/granny-killing alleged nature of Obamacare gets a lot of Americans angry.

The problem is, there just aren't enough liberals in this country. There just aren't enough people who, long before this battle was joined, had a deep and abiding mistrust of the fat cats. The fat cats are always going to have more money. Our side can't win genuine reforms unless we have the raw numbers to counterbalance their money. And we simply don't.

A couple of weeks ago I told you about Gallup polling data that showed Democratic pluralities in more than 40 states -- but also showed that self-described conservatives outnumbered self-described liberals in all 50 states. (There were also a lot of moderates.)

That's why the right-wingers won August -- there are simply more people in this country inclined to right-wing anger than inclined to left-wing anger. We haven't sold the notion that the powerful will walk all over us if not held in check -- whereas think tanks and the right-wing media and the GOP have done an excellent job of selling the notion that the government (or at least Democratic governments) will walk all over us if not held in check. That argument simply resonates with a much larger group of Americans.

We thought electing Obama and a Congress with big Democratic majorities meant we'd made it to the mountaintop. But the mountaintop was a long way away, and in a way we'd barely begun the climb. We still haven't.