The global pharmaceutical business is bigger than some nations’ entire GDP! They play high-stakes poker in a world where finding the new medical silver bullet spells a massive surge in sales, sky-rocketing stock pricing and unbelievable bonuses to those involved in the chain of revenue generation. Given the billions of dollars spent on research, it is little wonder that disclosing and explaining “side effects” to miracle drugs has spawned an entirely new generation of doctors with public relations jobs. Spin. Marketing. Curving bad results into just minor bumps along the road. Intimidating influential medical professionals who dispute the claims of big drug companies, cutting off research grants, influencing academic tenure decisions, and making life living hell for the academic practitioners who “get in the way” of a new miracle d rug… and proving grants and funds for those who cooperate.
The stories that came out of Merck’s Vioxx campaign are the stuff of legends… a campaign of fighting tooth and nail against doctors who pointed out the cardiac problems (that were taking an increasing number of lives) in the battle to prove that the new cox-2 inhibitors – like Vioxx and Pfizer’s Celebrex – were miracle arthritis drugs with no real side effects… except for an increased likelihood of death, it turns out. Vioxx is no longer with us, and most knowledgeable doctors are wary of this entire category of drugs these days. But how do the pharmas get away with crushing the negative but accurate information discovered by seemingly impartial academics just doing their jobs? Money, of course.
Let’s just take one example of how pervasive big pharma money is in one of the most basic units of medical education, the arena where doctors narrow their focus into their specialties, the critical years(s) of residency. According to the February 22nd Archives of Internal Medicine report, entitled Pharmaceutical Industry Support and Residency Education, which polled the directors of varying hospitals’ residency programs to see how much pharma money was used in support: “In all, 236 program directors (61.9%) responded to the survey. Of these, 132 (55.9%) reported accepting support from the pharmaceutical industry. One hundred seventy of the 236 program directors (72.0%) expressed the opinion that pharmaceutical support is not desirable. Residency programs were less likely to receive pharmaceutical support when the program director held the opinion that industry support was not acceptable (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02-0.22). Programs located in the southern United States were more likely to accept pharmaceutical support... The American Board of Internal Medicine pass rate was inversely associated with acceptance of industry support: each 1% decrease in the pass rate was associated with a 21% increase in the odds of accepting industry support…”
Look, the residency programs need the money, and the doctors need the residency programs. Medical schools are equally unlikely to turn down massive grants for academic positions and research, and medical periodicals, the ones that accept advertising, are unlikely to turn away drug companies from buying space. Yet look at the incredible conflict of interest inherent in this process. In the last administration, there was an official policy of populating the highest reaches of the FDA, Health and Human Services, etc. with personnel whose most recent jobs included representing big drug companies in their efforts to promulgate new drugs and stifle criticism. The policy of government de-regulation actually included pulling dedicated government professional off the path of verifying drug company claims and possible inaccurate data submitted in support of various new pharmaceuticals.
The area of pharma support for the medical profession, and the educational process that is a necessary part of that profession, requires balancing. But most of all, it requires an uninhibited and free press, doctors who are not afraid to speak the truth and government regulators whose job it is to keep the public safe. If any one of those arenas is compromised, the people who trust the medical system will pay with the quality of their lives, if not their actual lives. And if there were ever a place I want government to be my advocate, a patient’s advocate, it is in the arena of pharmaceutical influence over my life.
I’m Peter Dekom, and I approve this message.
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