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    Tuesday, June 03, 2003

    Flood the Zone: Is there an agenda at the New York Times against drug companies? Derek Lowe seems to think so. And so does
    Robert Goldberg writing at National Review Online:

    The Times article is part of a war the newspaper has been waging against pharmaceutical research and development for a number of years. The theme is always the same. Drug and biotech companies develop drugs of marginal value, and then corrupt the practice of medicine because they market their products and pay for research on the drugs by themselves. The solution is also always the same: Let the government determine what the best medicines are, and require doctors to follow the state's guidelines.

    I don’t always get those messages from the Times coverage of the pharmceutical industry. Maybe because there’s a kernal of truth to each accusation:

    Drug and biotech companies develop drugs of marginal value..

    For the past several years that’s what they’ve been doing, concentrating on developing copycat drugs rather than developing new drugs. Everyone’s got a proton pump inhibitor which they market as much for indigestion as they do for ulcers; everyone’s got a non-sedating antihistamine. And in the case of Schering-Plough now that Claritin is over the counter, they’ve got a copycat of their own drug, too. Ditto with Prilosec. Now that its patent has expired, AstraZeneca has got a copycat of it. (Nexium, the "other purple pill.") Defenders will say that there’s nothing wrong with this. That they use the profits from those fast and easy sure things to fund other research into new drugs, but sitting on the receiving end of all their advertising hype about those drugs makes them seem lazy and greedy. Of course, if we doctors didn’t fall for the hype, they wouldn’t have a market for the copycats.

    Which brings me to the next point:

    ...and then corrupt the practice of medicine because they market their products...

    It’s the way they market them that’s so objectionable. They ride piggy-back on the good will the public has toward science for one thing. Take direct to consumer advertising of drugs. Antihistamines claim in television and print commercials that they’re better because they’re “approved for indoor and outdoor allergies.” It may be true that they were clever enough to ask the FDA to give them that sort of label, but all antihistamines work the same way. There aren’t separate disease pathways for indoor and outdoor allergens. An antihistamine can’t distinguish between dust mites and flower pollen. Yet, patients routinely reject my offer of a prescription antihistamine because they want the one that works for indoor and outdoor allergies. (As seen on TV!) The most amazing thing is that these advertisement claims are so often accepted without any sort of scrutiny on the part of the consumer. In fact, it’s difficult to convince people sometimes that the commercial has shaded the truth. They assume too often that because it’s a medication the ad is being held to a higher standard of truth than a car commercial. It isn’t.

    ... and pay for research on the drugs by themselves...

    This one is a little trickier. It may be impossible to avoid bias in research, whether the grant is supplied by the government or by industry. Take, for example, the recent onslaught of obesity-related research papers. We have the government’s war on obesity (which has spawned numerous NIH grants on the subject) to thank for those. There’s always a temptation to put the most positive spin on results, no matter who funds them. Having the study support the original hypothesis not only feeds the ego, but it helps to get more grants in the future. And papers are more likely to be published if they show a positive result than if they show a negative result. But funding of legitimate research with legitimate grants isn’t really the issue here. The issue is the evidently common practice of drug companeis hiring people to write favorable review articles about their drugs and to do small “clinical trials” of dubious merit to promote the drug. And, in the case of one Canadian researcher, of quashing the results of a legitimate trial when it didn’t find in favor of the drug. Those are practices that deserve to have the media spotlight shone on them. And how.

    ..The solution is also always the same: Let the government determine what the best medicines are, and require doctors to follow the state's guidelines.

    Maybe I’m not reading those New York Times articles closely enough, but I’ve never come away with the impression that the paper advocates a statist approach to medicine. However, the FDA does play a critical role in checking the less altruistic motives of the businessmen who run the drug companies. Sure, drug companies take tremendous risks to develop new drugs and bring them to market. But they’re companies, run by men and women whose job it is to make a profit. Nothing wrong with that, but if allowed to run unchecked, the temptation to favor profit over safety and effectiveness would win out every time. It’s human nature. After all, the business people who run the companies have to answer to board members and shareholders every day (or at least quarterly.) They never have to face consumers. Or at least they wouldn’t if it weren’t for the FDA.

    But FDA approval isn’t the same as state-imposed guidelines. Doctors are currently given a lot of leeway to use drugs for uses that aren’t approved by the FDA. Where it becomes a problem is when the drug companies promote their drug for those uses. It may seem like splitting hairs, but there’s a world of difference between a physician deciding to try a drug on an individual basis for an unapproved treatment (say using a seizure medication for neuropathic pain) and flooding the market with claims of effectiveness for an unapproved treatment. In the first case, both patient and doctor know that the trial is an experiment. In the second case, it comes too close to being promoted as the standard of care - without proof of effectiveness.

    The New York Times may very well have an agenda against drug companies. They generally have an agenda against most companies - except of course The New York Times. But, in this case, the media attention is warranted. Someone has to keep the industry honest.

    posted by Sydney on 6/03/2003 06:50:00 AM 0 comments


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