How Does Big Pharm Buy Access to State Legislators? Especially if they don't want to look like they're directly hand in glove with the states? Why, go give your pitch, as well as a lot of money to 5013c companies that will then go back and pass legislature on your behalf. And, sadly, this particular group, Women in Government, doesn't see anything skewed about this at all.

In March 2007, I interviewed Susan Crosby, the President of WIG. Crosby first served on the board of WIG and then joined the staff as Deputy Executive Director in 2002. Crosby was a Democratic member of the Indiana House of Representatives for 12 years prior to her tenure with WIG. In 2005 Crosby's total compensation package from WIG was $123,925.

When asked what WIG offers its members, Crosby noted that besides the networking opportunities, WIG itself serves as a resource in several ways, including, "having legislators be able to call in and get totally unbiased information

Part 1, Part 2 and Part4 of this series on HPV are at those links.

So far, Merck had encouraged women to "Make the Connection" and "Make the Commitment." Those were low-key efforts compared to the most significant pre-approval effort -- the "Tell Someone" commercials. This is not a new technique by any means. In his 1928 classic, "Propaganda," father of the modern PR industry Edward Bernays described at length how it is not enough to sell a product. Instead, you need to sell the vision that will lead to desire for the product, with the consumer believing that it is their own idea. The "Tell Someone" spots did not mention Gardasil since it was not yet FDA approved, but did include Merck's name and logo. They showed actors portraying everyday women being shocked that HPV is so prevalent and that there is a link to cervical cancer. "I was stunned at how many people have HPV. I was stunned. Millions? That's insane," says one woman. With a sense of urgency, all the women pledge to tell someone they love, while pointing to a speech bubble on their plain white t-shirt that says "Tell Someone."

In a May 2006, article, Bloomberg News' Angela Zimm and Justin Blum noted that not everyone was taken in. "Gary Ruskin, executive director of Commercial Alert, a consumer group based in Portland, Oregon, that is critical of drug company advertising, said Merck's promotional Web site on the viral connection to cervical cancer is 'deceptive and dishonest. Merck doesn't tell you why the site exists, which is to sell Gardasil,' Ruskin said." Kelley Dougherty, the Merck spokeswoman, protested that the campaign wasn't about Gardasil. "This campaign is part of a broad and longstanding Merck public health commitment to encourage education about the disease."

However, the Bloomberg article also cited Richard Haupt, executive director of medical affairs in Merck's vaccine division, stating that the company has "invested in public affairs and consumer education more than we've done for any vaccine in the past." (emphasis added.) The Bloomberg reporters calculated that Merck spent $841,000 for Internet ads on HPV's link to cervical cancer in the first quarter of 2006 alone. In April 2006, they bought 295 TV advertising spots for the HPV campaign, followed by 788 spots in May. It wasn't until June 2006, that the FDA approved Gardasil.

What about free vaccinations?

The idea of mandating HPV vaccination for girls as a requisite for school attendance may seem helpful, or at worst benign, but this isn't the case. Government mandates often create requirements, but not the funding to fulfill them. Even a government recommendation can have far reaching effects on access. On June 8, 2006, the U.S. Food and Drug Administration approved Gardasil as the first vaccine against Human Papillomavirus (HPV). Less than a month later, the Advisory Committee of Immunization Practices (ACIP) unanimously recommended vaccination for 11 and 12 year old girls. According to the Oncology Nursing Society, the ACIP also "resolved that the HPV vaccine be included in the Vaccination for Children (VFC) Program, a national effort that provides free immunizations to children who are Medicaid eligible, uninsured, underinsured, or Native American. 'About 40%