Monday, January 14, 2008

Big Pharma – A Call for Balance and Fairness

This week the AARP Bulletin, a publication directed to over 40,000 Americans over 50, came across my desk. A Bulletin article Ties That Bind, opens with this paragraph,

For years, pharmaceutical companies have courted America’s doctors with an ever growing intensity, showering them with billions of dollars’ worth of gifts, consulting fees and trips to persuade them to prescribe to their drugs.

The article describes how,

• doctors have created the websites No Free Lunch and Pharmed Out to resist Big Pharma’s blandishments;

• the Institute of Medicine is drawing up guidelines for doctors to avoid conflicts of interest’

• medical schools and Congress are acting out against drug companies by restricting gifts and trips;

• Pennsylvania and South Carolina are hiring their own drug reps to “unsell” brand name drugs and to promote safety and efficiency;

• drugmakers are spending $7 billion a year to “win the hearts and minds of doctors” and another $18 billion and free drug samples;

The article paints a grim picture of an army of 101,000 drug reps descending upon unsuspecting office based-physicians, and asserts doctors are subconsciously vulnerable and gullible to marketing messages and financial inducements and other favors. .

All of this may be true to some extent, and it no doubt resonates with economic populists, who condemn Big Pharma as a major villain behind high health costs.

But is it fair to condemn Big Pharma out of hand without presenting a balanced picture?

The AARP Bulletin doesn’t mention the argument’s other side – that doctors in their offices are Big Pharma’s biggest customers and without them there would be no profit, that putting a new drug on the market costs $850 million, or that Big Pharma is by far the single largest source of innovative new drugs, employs huge numbers of people in states like Connecticut and New Jersey, produces the new drugs, like statins, that have significantly reduced heart attacks and strokes, and kept million of people out of hospitals; and supports somewhere between ½ to 2/3 of CME programs, which physicians are obligated to attend to stay in practice.

The piece quotes Jerome K. Kassirer, MD., former editor of the New England Journal of Medicine. He says doctors are being bought by Big Pharma. Since the early 1980s, when then editor Arnold Relman, M.D., warned of the for-profit medical industrial complex as American health care’s undoing, and his wife, Marcia Angell, MD, who later served as acting editor, the New England Journal has crusaded against for-profit health businesses, particularly Pharma. I find this attitude puzzling. even duplicitous, since the Journal would not exist without pharmaceutical advertising. If it‘s true to its beliefs, the Journal should simply refuse to accept pharmaceutical advertising.

We need to keep our balance when criticizing Big Pharma. It has its excesses, which should be addressed, but its successes too, which should be acknowledged. The pharmaceutical industry will remain a vital part of American health care economy, America’s largest single economic sec

1 comment:

P-Dawg said...

I think that is a very interesting point about the NEJM not taking big pharma bucks. Of course they can not stop, as they would be out gunned in a matter of months by other journals that do. Also, the whole existence of medical journals is supported by pharmaceutical (and other) companies trying to promote thier drugs with sponsored "research" that is very weak. But, my IRA is riding with Big Pharma and not with the kind folks at NEJM.