Wednesday, March 21, 2007

The Marriage of Medicine, Mother Pharma and Uncle Sam....

Big Pharma has been closing its gap on medicine in the last two decades. It is hard to find physicians in academia or high level positions of influential medical advisory boards that have not been tapped by the fertile green hands of big pharma. They come dressed as attractive young drug reps, carefully chosen by these companies to have enough look appeal to help them across the doors and thresholds of doctor's offices. Not all welcome them equally, but when they're sporting a potential $750 honorarium for a speaking engagement expounding the virtues of their drug, the poorly paid doctors of our times succomb. Perhaps if the system were different, and doctors didn't have to look for external sources of income to survive (that in itself is ludricous), would the doctors then stay devoid of this corrupting influence. It's no longer pristine. The editors of major medical journals have written that they can no longer guarantee that the studies published in such respected journals as The New England Journal of Medicine and JAMA are free of commercial bias. Sure, any relationships the authors may have with the sponsoring company must be disclosed, but what is not disclosed is how the data may be distorted, how the authors of the papers themselves may not be the real author (instead a ghost writer hired by the drug company), or how the drug company may have only revealed parts of the data from their randomized-controlled trial to the authors that must publish a commentary on the results (obviously to favor their drug). Why would a drug company do otherwise? Their purpose is not to promote the general health and well-being of the population if it does not meet their needs of promoting and selling their highly expensive developed product. Thus knowing that they cannot influence doctors directly without evidence, they have infiltrated the system to make the evidence and guidelines come from seemingly impartial doctors.

But an article in today's NY Times, "Doctor's Ties to Drug Makers are Put on Close View" points out how far these relationships have gone. The amount these doctors that speak on behalf of the sponsoring drug company's products may receive over several years can be as high as the hundreds of thousands. The amount is even higher if the doctor is performing research that could benefit the drug company. The article used the example of Dr. Allan Collins, President of the National Kidney Foundation who had received honorariums from Amgen anywhere between $10 - 20,000. However, the interesting thing is he denies receiving more money in an email, stating that a "contract amount of $1.9 million from Amgen was paid to the Minneapolis Medical Research Foundation (MMRF) for the research contract, on which I am the designated senior researcher." Maybe I'm wrong, but last I checked a senior researcher receives a stipend from his or her research grants. So indirectly, he did receive an unaccounted sum from Amgen. Whoever thinks that may not influence prescribing patterns is deluding themselves. Studies have shown that doctors that have relationships with the drug makers tend to prescribe the newer, pricier drugs they are pushing. Well, don't expect big pharma to be pushing the older, generic and cheaper drugs, of course, because they might be in the best interests of controlling rising healthcare costs. That's not where the money is made. So the interests of the population are mixed with the interests of big pharma under the disguise of a respected physician expert in the field. It's the shrewdest game of deception. Other doctors go to these pharma sponsored dinners to hear an "expert" who is being paid by that very same drug company to give the lecture. Would the drug company pay a physician to get up and speak against its drug? It's the big bad wolf in Grandma's clothes, except the wolf has convinced someone else to dress up like grandma that actually looks like grandma.

An article in the NY Times immediately followed today's article on deceptive pharm influence with the title, "FDA rule limits role of Advisors Tied to Industry." This seems to be an important step in the right direction because for the first time experts that have received money from drug or device makers would not be allowed to vote in the advisory committee hearings that decide on the approval of new products. On the surface this sounds good, but they've allowed a loophole, of course, with any doctor that has received less than $50,000 (a sizeable amount in my books) in the prior year still allowed to participate in these committee hearings. Well, why allow ANY amount at all. In my opinion, if there's money in the game, influence is being exchanged under the table.

Dr. Lutter, FDA acting deputy commissioner, stated, '"The $50,000 threshold is something that we think strikes an appropriate balance between' getting smart advisers and reassuring the public that their advice is not tainted." Well that's a bunch of hogwash! Maybe what he's really saying is that all of the smart advisors have already been infiltrated by the drug industry. Is there no stone unturned? Needlesstosay, I remain skeptical. Why aren't they jumping to make the panels that come up with national treatment guidelines devoid of pharmaceutical influence?

Let's call a spade a spade. If national treatment guidelines are produced by a panel of experts, the majority of which have received money from the drug companies, don't call them "Expert Treatment Guidelines," call them "Grandma's Suggestions on what Drugs to Take to Stay Young and Keep up the Drug Company's Record Profits."

3 Comments:

Blogger The Independent Urologist said...

Pure hypocricy, isn't it. Since I was resident I learned quickly that most clinical research is actually advertising, either for a device, a drug, or a doctor. Plain and simple.
Nice post.

8:42 AM EDT  
Anonymous Bonnie said...

My background is all alternative healthcare, which has typically been distrustful of pharmaceuticals. It's still surprising to note how far big pharma has infiltrated the medical system.

Healthcare shouldn't be a money making vehicle of this sort. It's too bad that many lay people think paid when in actuality it's the large corporations that have gotten their hands on our well being.

2:30 PM EDT  
Blogger ObGynThoughts said...

Thank you for this post. I feel the same way, and, as a response, do not see drug reps in my office. a. it saves me time. b. it keep my mind clear. If I need to know something, it will show up in my medical journals. c. reps manipulate you in very subtle ways that are hard to detect. Sometimes it is just the criteria for something. A drug rep might say " the important criteria in selecting xxx is a". Even if you are sceptical about what he conclused, which invariably results in his product being the answer, even then you may believe his criteria. And that in itself turns out to be wrong and may mislead you in the future.
An example: Drug reps talk about the advantages of one oral contraceptive over another and show you "studies" that prove that their OCp is better, that it is better tolerated, better accepted, has less breakthrough bleeding etc.
In reality there the only criterion is the body and the unique response of the patient to an OCP. Nobody can predict it. And for that reason there is no suhc thing as "chemistry", as a "starter pill" (every pharma company would love to have the started pill), as a pill especially for breakthrough bleeding, as a pill for PMS and so on. All nonsense.
Do not believe a word of waht they say. Female drug reps often are former cheerleaders, and pharma companies approach cheerleaders specifically because of the "attitude". They easily earn 120 K for serving sandwiches and rattling off a few memorized sentences. This is a slap in the face of our recent graduates who earn that amount after many years of training and with a lot of responsibility.
Your ObGyntoughts, Matthias Muenzer, MD, Boston

8:56 AM EDT  

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