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Sunday, December 15, 2002It is a sweeping indictment of the drug industry. Its central argument is that drug companies depend on government-funded research to develop drugs and then make obscene profits by bringing the final product to market. I’m not sure that’s a valid criticism. Surely, the drug companies have some researchers in house, people, like Derek Lowe, who spend their working days trying to develop new drugs. The article offers as proof or their assertion the results of a study published in Health Affairs: The study reported that in 1998 only about 15 percent of the scientific articles cited in patent applications for clinical medicine came from industry research, while 54 percent came from academic centers, 13 percent from government, and the rest from various other public and nonprofit institutions. But how many of those articles from academic centers encompassed research funded by grants from the pharmaceutical industry? As the authors note elsewhere in their manifesto, these days the distinction between industry and academia is hopelessly blurred. It’s hard to find a researcher who doesn’t have some ties to the pharmaceutical industry, and it’s even hard to find research that isn’t funded at least in part by them. So hard, in fact, that The New England Journal announced not long ago that they would no longer bar writers of review articles who had any connection to pharmaceutical or biotech companies involved in the topic of the article. They couldn’t find any experts without ties. Angell and Relman detail the drug companies’ successful efforts to end-run the patent system, including copy-cat drugs and dubious patent claims and lawsuits against generic companies. They fail to mention the influence of “pharmaceutical benefits management” companies that are owned by drug companies. These are entities paid by insurance companies to manage the drug benefits of their beneficiaries. They’re often, as in the case of Merck-Medco, owned by the drug companies. Merck-Medco is just plain Medco now, but Merck has still held them to a promise to push Merck drugs. They have no interest in allowing the cheapest, most effective drugs for their beneficiaries, but every interest in pushing Merck products. So, when a new copy-cat drug comes out to dodge a patent expiration, they send out notices advising physicians to switch patients from the old drug to the new. They say the new drug is the "preferred drug." They don’t care about cost or effectiveness. Their “formulary” is designed to increase market share for their parent drug company. The article’s greatest strength, though, is in its details of the marketing of drugs to doctors, and in the medical profession’s willing acquiesence: The atmosphere at many large medical meetings resembles a bazaar, dominated by the presence of garish drug company exhibits and friendly salespeople eager to ply physicians with samples, gifts, and services while they pitch their company’s drugs. In the exhibit areas adjacent to the meeting rooms, physicians wander through a carnival-like scene. Many carry large canvas bags, bearing drug company logos, stuffed with goodies. That, sadly, is an accurate description of most large medical meetings. It’s a disgusting sight. Unfortunately, it’s also true that a lot of physicians, and most medical societies have no interest in changing that behavior. Physicians have come to think of free handouts as a perq of the job. Medical societies and professional organizations have come to rely on drug company “sponsors” to finance their educational meetings. As a profession, we’ve pretty much prostituted ourselves to the pharmaceutical industry. Angell and Relman correctly include the medical profession in their call for reform. There is too much collusion in research and too much marketing to physicians. But they fail to mention the role that medical journals and their editors play in this, too. It’s the journals that publish the studies with biased findings. The journal editors who allow authors of papers to cast their results in the most positive of lights with misleading statistics. Who make no distinction between statistical significance and clinical significance. Who send out press releases to the media to hype the research of the week - press releases that parrot the optimistic conclusions of the authors. That media attention is just as influential in hyping a new treatment or drug, to both doctors and patients, as any marketing campaign. (For more on this, click here.) The authors express little hope that things will change, citing a Republican Congress as a likely road block to reform. This is odd, given that they cite plenty of examples of Democrats who have been just as culpable in laws favoring drug companies, and they note that the pharmaceutical industry gives liberally to politicians of both parties. The current state of affairs didn't arise de novo over the past two years of a Republican Administration. A lot of it evolved during the 1990's, during the reign of a Democrat. The reason they despair of the current Republican leadership is that their ultimate solution isn't aimed just at solving the problems of high drug prices. Their ultimate solution dove-tails nicely with Marcia Angell's other project - campaigning for a national healthcare system. At the very end of their very long treatise, they call for a single-payer system, arguing that one payer could negotiate better drug prices than our current multi-faceted system. Such a system would certainly lower drug prices, but it would also force a lot of drug companies if not completely out of business, at least out of the business of making new drugs. Single-payer systems give all the advantage to the payer, and none to the seller. It's a reverse monopoly, and like all monopolies, it's no good. It would be far better to allow market forces to bring down the price of drugs by having the people who use them bear the responsibility for buying them - especially in the cases of those chronic conditions with a wide choice of drugs to treat them - like arthritits, diabetes, and hypertension. It would be far better to legislate reform that addresses patent system abuses so that competition within the industry can be increased. It would be better to eliminate marketing to consumers and doctors. Let a drug be evaluated and adopted on its merits rather than the company sales pitch. Then, the money that’s being used to feed doctors could be used to feed research chemists. Finally, we need reform of the leadership of our medical journals. Editors need to take more responsibility for the spin their authors put on their papers, and they need to stop using that spin for their own ends - keeping their journals in the public eye. Surely, two former editors of The New England Journal of Medicine could do something about that. NOTE: I fixed the broken links that appeared here earlier. UPDATE: The BMJ has taken the lead in transparency of competing interests for medical journals. They've posted their competing interests on the internet. posted by Sydney on 12/15/2002 07:55:00 AM 0 comments 0 Comments: |
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