1-1banner
 
medpundit
 

 
Commentary on medical news by a practicing physician.
 

 
Google
  • Epocrates MedSearch Drug Lookup




  • MASTER BLOGS





    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov




    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.




    "Opinions are like sphincters, everyone has one." - Chris Rangel



    email: medpundit-at-ameritech.net

    or if that doesn't work try:

    medpundit-at-en.com



    Medpundit RSS


    Quirky Museums and Fun Stuff


    Who is medpundit?


    Tech Central Station Columns



    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews

    Review


    Medical Blogs

    rangelMD

    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc

    richard[WINTERS]

    code:theWebSocket

    Psychscape

    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It

    medmusings

    SOAP Notes

    Obels

    Cut-to -Cure

    Black Triangle

    CodeBlueBlog

    Medlogs

    Kevin, M.D

    The Lingual Nerve

    Galen's Log

    EchoJournal

    Shrinkette

    Doctor Mental

    Blogborygmi

    JournalClub

    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House

    .PARALLEL UNIVERSES.

    SoundPractice

    Medgadget
    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day

    BioEdge

    The Business Word Inc.

    Point of Law

    In the Pipeline

    Cronaca

    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station

    Blogcritics

    Overlawyered.com

    Quackwatch

    Junkscience

    The Skeptic's Dictionary



    Recommended Reading

    The Doctor Stories by William Carlos Williams


    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn


    Intoxicated by My Illness by Anatole Broyard


    Raising the Dead by Richard Selzer


    Autobiography of a Face by Lucy Grealy


    The Man Who Mistook His Wife for a Hat by Oliver Sacks


    The Sea and Poison by Shusaku Endo


    A Midwife's Tale by Laurel Thatcher Ulrich




    MEDICAL LINKS

    familydoctor.org

    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info

     



    button

    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

    0 Comments:

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page

    Ads

    Home   |   Archives

    Copyright 2006