In 1992, Kathleen Slattery-Moschkau was an attractive grad fresh from college when the pharmaceutical industry recruited her for a lucrative job as an industry drug rep. It was a dream come true for the 23-year-old political science major. Fat salary, hefty bonuses and a company car in return for getting doctors to prescribe the pills she peddled.

Now 36, Slattery-Moshkau has traded her pill samples for the director's seat. Her debut film, Side Effects, is a comical twist spun from the duplicity of one of America's largest industrial complexes, whose tentacles reach from Congress on down to the office of your primary care physician.

With rising health care costs a perennial gripe on Capitol Hill, and reductions in prescription drug benefits a continual worry, pharmaceutical companies have done little to address these concerns. In fact, they have managed to exacerbate the problem. Over the last 15 years the industry has shied away from developing cures, vaccinations and symptom easements, pumping billions instead into the marketing of "me-too" drugs, which are simple reformulations of existing drugs.

Of the 487 drugs approved by the Food and Drug Administration between 1998 and 2003, just 67 were considered new compounds, with even fewer deemed improvements over existing drugs. Because they are cheaper to produce and have a ready-made market, the industry has come to increasingly rely on me-too drugs, according to Marcia Angell, author of The Truth About the Drug Companies: How They Deceive Us and What To Do About It.

For 10 years Slattery-Moschkau worked as a local drug rep for companies like Bristol-Meyer and Johnson & Johnson. She provided doctors with drug samples to provide patients, mingled socially with physicians, all the while apprising them of the research being conducted on the pills she pushed. The more pills that doctors prescribed, the more money Slattery-Moschkau made. She reasoned that getting life-improving medications into the hands of patients was a virtuous undertaking, even if the tactics were questionable. But five years in, industry realities began squaring with her moral rectitude. Yet, attempts to unloose from corporate America's "golden handcuffs" were subverted by fat raises and five-figure bonuses for five more years.

Around the time she finally bid farewell to the industry in 2002, an anti-inflammatory drug called Vioxx was being recalled by its manufacturer, Merck & Co., after subsequent studies showed the risk of heart attack or stroke doubled in those taking Vioxx versus a placebo. In the last three years, more than 7,000 Vioxx-related lawsuits have been filed. Testimony in the first Vioxx-related federal lawsuit against Merck began last week. In response to analyst predictions the litigation could take Merck for more than $50 billion, the company last month announced plans to lay off 7,000 employees and sell or close 31 of its plants.

Slattery-Moschkau married this industry nightmare with her own experiences hustling for it. The product was Side Effects, a heartwarming movie about a young drug rep torn between right and wrong. The film, shot in Madison on a shoestring budget of $190,000 over 18 days in the spring of 2004, was a sellout at last spring's Wisconsin Film Festival and has to some great acclaim been shown in theaters around the country. Side Effects plays this weekend at Westgate Mall. (See movie times, page 20) Slattery-Moschkau and her production team will be at J.T. Whitney's across from the mall to answer questions after Friday night's showing.

Slattery-Moschkau recently sat with coreweekly to discuss how pills enter the market, why the government isn't doing more to protect us and where consumers can go for objective information on the pills they pop.

CW: Why are prescription drugs so expensive?
KSM: Turn on your television set. Seriously, they're spending twice as much on marketing as they do on research and development. When the industry cries and says, 'Prices are high because of research and development, and OK, we'll lower our prices but then you're at risk because we won't be able to do research and development anymore,' it is bullshit! One physician made a very basic statement, 'If you build a better drug, we will come,' meaning that if you build a drug that is more effective and safer, you won't need to run advertisements 24/7; you won't need an army of 90,000 sales reps out there. Right now they make a lot of 'me-too drugs.' They'll look at the anti-depressant pie and say, 'Oh My Gosh, that's a nice, big lucrative pie. We should make an antidepressant because we're good marketers.' Instead of developing something that truly makes a difference, they develop these 'me-too' drugs and what it really comes down to is who's the better marketer, not who's developing the better drug. We're essentially paying for their marketing budget every time we go to the pharmacy.

CW: In the movie it is said that drug reps know just enough about the drugs to not be negligent. Can you elaborate on this?
KSM: The reason why they hire people with no science background is because the reps then have no basis to question anything they're told to say. They'd give me a study, I'd highlight the pros and they'd teach me how to say the big words. But if a doctor ever asked me anything outside of that specific drug or disease state, I would glaze over. Every rep is an expert at avoiding these questions. I could really only quote the benefits of the drugs we had training sessions on. The scary thing about this is that none of these diseases or pills occurs in a vacuum; they all occur together. So, if you're taking multiple pills a day, you better darn well understand how these pills affect the body as a whole. I mean, the only information I'm giving doctors is what I'm being told to say by my company. A physician I recently spoke to said that's scarier than getting no information at all, because if he has no information, he's not going to write the prescription. If he has only the positives when there are so many negatives, like with Vioxx… Doctors didn't know about the cardiovascular risks because the company didn't tell them. Therefore, millions of people were put at risk.

CW: Shouldn't we focus on how the majority of patients benefit from drugs rather than the handful that experience unpleasant side effects?
KSM: Ask the widow whose husband died after taking Vioxx. You're right, any group of drugs have the potential to cause harm and sometimes it's not known until they've been out on the market for awhile and used by a large patient sample. The problem is that these drugs can cause bad side effects and oftentimes doctors and patients aren't aware of those side effects before they choose to pop that pill. The problem isn't that Vioxx will cause problems; it's that the information was suppressed by the company. Therein lies the problem. If everything is up front and the patient has a true choice, that this drug can really help your pain but here are potential side effects, then it's up to the patient. Vioxx, in most studies, was shown to be no more effective than Aleve, but was significantly more expensive than Aleve and had the dangerous cardiovascular side effects.

CW: Through the industry lens, are people consumers or patients?
KSM: Well, they're seen as both. The reason why they run all of those ads is because they work. They run an ad one day and the next day they can see a direct relationship between it and increased sales. With Vioxx, everyone saw Dorothy Hamill skating around the rink. Now, there is a whole generation of people that had a love with Dorothy Hamill and those were the same people who were now starting to age and ache a little more. It sounds so silly when we say it aloud, but that's really how it works. Those same people were then marching into their doctor's offices demanding Vioxx, which is exactly what the company wanted. It's not only that they're marketing a specific drug; they're also creating and marketing disease states. If they can get you to go into your doctor's office after self-diagnosing yourself with depression or anxiety or pain or some new disease they've made up, then they've done their job well. In your doctor's office you'll see sometimes on the waiting room table these surveys, a checklist asking, and 'Are you tired? Are you thistwo or more days a week? If you've checked so many of these, ask your doctor about depression.' They're actually getting you to self-diagnose because if they do, you're more likely to walk out with a prescription. It's a very premeditated marketing approach to both consumers and physicians.

CW: Aware of the unscrupulous marketing tactics, shouldn't doctors do more to learn about the drugs they prescribe?
KSM: There's a growing team out there that is trying to put together peer-reviewed, unbiased information. It's one of the biggest topics of concern right now because once you get past the reps you find that the studies are being funded by the industry. And with the FDA financially beholden to the industry, it's like, where do we get unbiased information? There are teams now across the country, which are independently reviewing classes of drugs and are almost putting out a 'consumers' reports' on these drugs for physicians. Even though an article might be published in a major magazine, the authors might have put their own spin on the summary. So, these bodies will take all the data and come up with their own conclusions, not some conclusion that an author has been paid to give.

CW: How accountable or complicit are doctors in prescribing potentially dangerous medicines?
KSM: Having worked in the industry for 10 years, I have the highest level of respect for physicians. That said, I think physicians sometimes think they're immune to the drug reps. They'll say, 'Yeah, I see drug reps,' or, 'I go to the lunches or the dinners and they don't influence me at all.' Again, the industry only does what works. When a rep takes a doctor out to a nice dinner at L' Etoile, that rep will see a direct increase in the number of sales of a particular drug. All of this is tracked very carefully. Because we have the prescribing history on every doctor before we walk into their office, I knew exactly what prescriptions Dr. Smith writes, how many prescriptions of, say, Prozac versus Paxil. So, I can tweak my message to counter exactly what he's been prescribing. They had no clue I was a political science major, they had no clue of our training tactics or anything else.

CW: Until things change, where can patients turn to for unbiased, objective information on the drugs they're prescribed?
KSM: The very first thing is knowing when you turn on your TV and you see all of these beautiful well-done commercials, that they're made for one purpose and one purpose only – to sell more of that particular drug. Doctors everywhere are saying, 'People are marching into my office demanding these drugs. If you don't give them to me, I'll go elsewhere.' The first thing patients must question is how they're getting their information. Unfortunately, at the moment, there isn't a great place people can go for this type of information. More and more people are conducting independent reviews of the data and eventually, hopefully, this information will trickle down to the consumer.

For consumer info on prescription drugs, go to http://crbestbuydrugs.com/.