Friday, April 18, 2008

The Pharma Apologists Are Backing Down

I've previously called attention in this blog to the writings of Dr. Thomas Stossel of Harvard, who appears to be ready to lend his support to the industry propaganda machine. That machine is sorely taxed of late with the Mass. legislature threatening to enact a law banning all gifts (read bribes) from drug reps to docs. So Dr. Stossel and his colleague, Dr. Dennis Ausiello, told the Boston Herald why this is such a bad idea.

You can read the op-ed in its native habitat at:
http://www.bostonherald.com/news/opinion/op_ed/view.bg?articleid=1087609
However, the Herald will not tell you a couple of things you'd like to know, that are listed on the Pharmalot blog: http://www.pharmalot.com/2008/04/massachusetts-docs-to-lawmakers-no-gift-ban/-- like for instance that Ausiello is a director at Pfizer and Stossel is a paid consultant to Merck, with each having several other major interests as well.

As I say, you can read the op-ed for yourself. But I thought that so much of what they say is instructive, that it was worth printing the whole thing below in italics, with my own comments in bold.

Conflicts don’t sicken health care
By Dennis Ausiello and Thomas P. Stossel Thursday, April 17, 2008 Op-Ed
Many discoveries leading to extended longevity and improved life quality originate in Massachusetts clinics and laboratories. But they only benefit our citizens because of the private companies that develop, manufacture and sell medical products.
Therefore, for the Legislature even to deliberate passing a law imposing fines up to $5,000 and jail sentences up to two years on practicing physicians if they accept a pen, pad of paper or slice of pizza from a company representative reflects the success that critics hostile to commerce in general have had in capitalizing on profound misunderstandings of how these companies interface with medicine.
The real intent of these critics goes far beyond food and trinkets, and its true purpose is to curtail strictly or even eliminate all contacts between physicians and private industry. We strongly oppose this agenda.


Good golly gosh. Most of us critics of the medical profession's too-cozy relationships with Pharma thought that we were trying to get rid of financial conflicts of interest, while permitting all sorts of contacts and relationships between the profession and the industry--namely, all those contacts and relationships that did not result in docs lining their pockets with industry cash. We never thought that we were opponents of industry-professional exchange of information--far less that we were opponents of "commerce in general." We are sure grateful to these two perceptive physicians, who obviously know our true motives much better than we do ourselves.

Despite extensive training, physicians cannot know the details of all products, especially new ones. Therefore, company salespersons complement physicians’ information derived from many sources. They tell physicians about a limited range of products about which their employers train them under strict FDA regulations.

If you believe that today, drug reps's spiels to docs are "educational," and that they always adhere to strict FDA regs, then let me sell you some swamp land in Florida. The so-called value of reps's contacts with docs as a way to keep docs informed about new drugs has been so thoroughly trashed in a voluminous literature that no more need be said.

The proposed state gift prohibition aims at the misperception that the company sales representatives use gifts - essentially bribes - to cajole physicians into using company products, and that such use is medically inappropriate and unjustifiably increases costs.
Little evidence supports these concerns.

Well, at least we got them to say the key word, "bribes." As to the assertion "little evidence supports these concerns," read HOOKED.

Federal laws already prohibit bribes and kickbacks between companies and doctors, and other laws encourage whistle-blowing if infractions occur. At the state level, attorneys general enforce these laws. Company representatives providing small gifts or meals to gain access to doctors hardly amounts to bribery or kickbacks.

This drags out the old chestnut about small gifts being too piddly to influence anyone so only gifts over a certain value count. The available research suggests that if anything, the opposite is true.

But to emphasize that physicians and students in the academic institutions where we work want to learn about products because it is good for patients, we support hospital policies that eliminate these practices but not the relationships per se.

Whoa--hold onto your hat. This is a HUGE concession among the pro-industry-entanglement troops. They are willing to admit finally that when you shovel freebies at docs, then the whole exchange takes on an unsavory atmosphere that is not conducive to public trust. That has been the critics' point all along.

Companies certainly use sales forces to encourage product prescribing, and encounters between detailers and physicians demonstrably accomplish this goal.
New brand products are inevitably more expensive than older, especially generic ones, and, in some instances, newer versions may add only incremental value. Deciding in such cases to prescribe older products may be appropriate.

Another huge concession--cheaper generic drugs may be just as good as the latest brand name stuff.

Unfortunately, defining such circumstances is often difficult, if not impossible. Although product prescribing always incurs costs, cost is not the only issue. What is more important is the cost benefit ratio in terms of better health. A good physician follows patients carefully and monitors their responses to whatever products have been prescribed.

Anyone want to argue with this? I don't.

Under the current system of product information, drugs are not even close to the top drivers of health care costs. Drug price growth in 2007 was 1.4 percent, and prescription medicines account for only 10 percent of health care spending.

That's true too, if largely besides the point. If we can get a handle on a smaller part of health care costs, while the larger portion is simply out of reach, why not focus on what we can control?

We believe that the best approach to optimize cost effectiveness of product prescribing is to promote more, not less, interaction among all stakeholders involved in health-care delivery, including company marketing reps.

That all went by me pretty fast. "Interaction among stakeholders" sounds like a great general propostion. So exactly how did we segue from that to drug reps? Are Ausiello and Stossel claiming that of all the folks who work for drug companies, the ones that it's most rewarding and useful for docs to engage with is the reps? The folks that have been shown on many occasions often not to have any science background before being hired by the companies; to be chosen primarily for good looks and nice personalities rather than knowledge (remember the former cheerleaders); and whose training and bonus incentives focus most of all on sell, sell, sell?

The language of the Legislature’s proposed anti-gifting bill is both severe and vague, inviting inquisitors and individuals with personal grievances to harass physicians involved in a large variety of potentially constructive research and educational activities. Such harassment will inevitably inhibit appropriate industry support of these legitimate activities.
The state should be cautious about embarking on the radical course epitomized by the law under consideration. It threatens to dismantle a system that has served us well, and is deeply disrespectful of physicians and companies alike.


"A system that has served us well"--as HOOKED and numerous similar books and articles have shown, the system that brought us 140,000 excess MIs from Vioxx, just to name the most obvious recent scandal. If the system has served us so well, from whence comes all the political pressure, at long last, to change it?

2 comments:

MedInformaticsMD said...

The real intent of these critics goes far beyond food and trinkets, and its true purpose is to curtail strictly or even eliminate all contacts between physicians and private industry. We strongly oppose this agenda.

Classic straw argument, with quite a bit of hysteria thrown in - and a touch of ad hominem. Stossel may be smart, but he's an amateur propagandist at best.

Company representatives providing small gifts or meals to gain access to doctors hardly amounts to bribery or kickbacks. But to emphasize that physicians and students in the academic institutions where we work want to learn about products because it is good for patients, we support hospital policies that eliminate these practices but not the relationships per se.

Stossel buries his agreement with the reformers in the middle of his piece. In essence, he's attacking the bloggers while claiming to support the views they've been espousing. How kind of him.

Typical academic. What a great idea you have! It is therefore my idea!

Harvard Medical School has a documented history of that, in fact:

"The Coin of the Realm, The Source of Complaints", Linda J. Wilcox, EdM, CAS, Ombud, Harvard Medical School, Journal of the American Medical Association. 1998;280:216-217, http://jama.ama-assn.org/cgi/content/full/280/3/216

anna said...

Nice post