Dose of bias is unhealthy

By John Abramson / As You Were Saying | Saturday, May 31, 2008 | Boston Herald | Op-Ed

Though the pharmaceutical industry does an excellent job of convincing doctors and the public that its mission is to improve our health, don’t be fooled - its real job is to sell drugs for the highest price.

I recently testified at a hearing in federal court concerning alleged illegal marketing activities that resulted in overpayment of several billion dollars for the drug in question. The judge opened the hearing by quoting the highly respected American Law Institute’s statement that the fundamental purpose of a corporation is to maximize profits and return those profits to its shareholders.

Though the pharmaceutical industry does an excellent job of convincing doctors and the public that its fundamental mission is to improve our health, don’t be fooled - its real job is to sell the most drugs for the highest price. And they do so by capitalizing on every opportunity to influence our beliefs about the need for and benefit of their products.

Providing gifts to physicians and financial support to hospitals for continuing medical education are an integral part of the drug industry’s strategy to achieve this goal. If these were the only sources of bias in what doctors believe is the best way to treat their patients, the legislation to ban these activities - courageously passed by the state Senate and pending in the House - would still be vital, but not of such critical urgency.

Unfortunately, they are just the tip of the iceberg. It’s what’s beneath the surface that is the real problem.

Over the past 30 years, the funding of clinical trials has been largely removed from the National Institutes of Health and taken over by the drug and medical device industries. Consistent with their fundamental mission, these industries design their research to maximize their return on investment. Medical knowledge itself has become a commodity, produced for its business value rather than its health value.

It’s not just the commercially biased “educational moments” that are the quid pro quo that come with the gifts to doctors. No, the problem starts with the “scientific evidence” that we doctors read in our most respected journals.

More than two-thirds of the clinical trials that are published in our most trusted medical journals are commercially sponsored. And the odds are five times greater that the commercially sponsored studies will conclude that the sponsor’s drug is the treatment of choice compared to non-commercially funded studies of exactly the same drug. (Wouldn’t it be nice to take those odds to the casino?)

In other words, what we naively think of as objective science is more often than not an extension of marketing - an infomercial.

This is an enormous problem and goes a long way toward explaining why Americans pay twice as much for health care as the citizens of the next 21 wealthiest countries, but actually live two and a half fewer years in good health than the citizens of those countries.

The drug industry has so much money and power that even raising these issues is a third rail for American politicians. The head of U.S. operations for drug maker GlaxoSmithKline recently attempted to wield some of that power when he threatened decreased investment in Massachusetts if the proposed ban on gifts is passed.

So if you want your doctor to be as independent of commercial influence as possible when deciding the best treatment for you and your loved ones, the gift ban is a necessary first step.

But we citizens also must be ready to exercise our power as consumers. The drug and medical device companies should know that blocking this legislation or not participating in a voluntary ban on gifts to doctors could result in a consumer boycott of their drugs and devices that have me-too therapeutic equivalents made by companies that are honoring the ban. This is the way to help the medical industry serve its shareholders by better serving the public interest.

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