I wouldn't want any of you to think writing this blog is easy. Among the things I sweat bullets over is whether to include posts about bad behavior of a drug company when it does not directly address the main theme of this blog, which is the ethics of the relationship between the pharmaceutical industry and the medical profession. When a drug firm does dirty without involving the medical profession in its nefarious deeds, then it seems like unfair piling on to make a big deal of it here. At the same time, if you don't know some of this background, it's hard to make sense of some of the other aspects of drug industry behavior that do impact more directly on medicine.
As often is the case, I'll refer you over to our friends at Health Care Renewal blog for the main details--
http://hcrenewal.blogspot.com/2013/01/how-revolving-door-and-other-aspects-of.html
--as well as to a recent newspaper editorial:
http://www.sacbee.com/2013/01/27/5141895/amgen-uses-its-clout-to-boost.html
What's at issue here is two actions involving the drug firm Amgen. First, as we noted in a recent post:
http://brodyhooked.blogspot.com/2012/12/yet-another-silly-integrity-agreement.html
--Amgen settled with the Feds for a $762M fine for illegal marketing of Aranesp, a drug for cancer and kidney disease patients that's dangerous in higher doses. Second, lobbyists for Amgen managed to sneak into the fiscal cliff legislation a special provision that favors another Amgen drug, Sensipar, by postponing for 2 years Medicare price controls for the drug. This will probably cost taxpayers an extra $500M, which by coincidence almost pays for Amgen's fines in the first case. Amgen won this special treatment in Congress thanks to its cozy relationships with, and generous donations to, Sens. Orrin Hatch, Mitch McConnell, and Max Baucus.
Here's the critical summation from HC Renewal: "In summary, Amgen seems to have leveraged its use of former legislative aides affiliated with both political parties as lobbyists, and its presumed influence over former employees who are currently legislative aides, that is, to people who have transited revolving doors in both directions, to influence policy in its corporate favor. It has also leveraged its contributions directly to politicians, to political action committees (PACs), and to non-profit advocacy groups to influence policy in its direction for this purpose. All this leverage apparently resulted in continuing government favoritism to a company the government had just convicted of a crime, and to a company whose actions likely led to sick and dead patients. Furthermore, legislators who publicly deplore excess government spending and enlarging government deficits supported spending more taxpayer money to favor a particular company that they ought to have shunned."
The Sacramento Bee's editorial concludes, "At the end of last week, a bipartisan group in the House introduced a bill to repeal the Sensipar provision. Given Amgen's clout, chances are slim the House bill will pass. But it's a good fight to fight." Seems like folks who care more about patients' health than about corporate profits do a lot of that--fighting the good fight against heavy odds.
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I'd like to request that Dr. Brody discuss another recent case involving Amgen, reported today the NYTimes, regarding Amgen's attempts to restrict/put safeguards on substituting biosimilars for name brand "biologics":
http://www.nytimes.com/2013/01/29/business/battle-in-states-on-generic-copies-of-biotech-drugs.html?ref=health
What is clear is that such restrictions will make it more costly for generics firms, thus reducing their competitiveness. Since Amgen has a serious conflict of interest here, as one of dominant competitors, their role here is rightly viewed with suspicion.
What isn't clear is the extent to which their arguments hold up, whether there is sufficient evidence to counter their claims and arguments, and whether the evidence is good enough to draw much of any conclusion at all.
From reading the comments section for the Times piece, readers' distrust of Big Pharma, and Amgen in particular, is abundantly clear. Three problems disturb me:
(1) From what I can tell, the bulk of the commenters reject the proposed legislation based almost entirely on mistrust, instead of the status of the evidence. Such resort to simple Ad Hominem arguments is very disturbing. Part of the problem, is that the same Ad Hominems also work against generics firms, for they have the same conflicts of interest here.
(2) The past shenanigans of Amgen and other big and small name pharma rightly provokes mistrust, regardless of how good their arguments seem, on the surface.
(3) Not a peep can be heard in the article from non-affliated scientists, the AMA, or any credible medical organization, regarding Big Pharma's proposed safeguard legislation.
All of this adds up to a devastating result: the focus of the discourse is almost entirely on who to root for - who are the baddies and who are the goodies. Lost in this toxic atmosphere is any focus on sound reasoning.
Consequently, Big Pharma bashing, while serving a vital purpose, also seems to be undermining more level-headed discourse. My fear is that this is turning into a Faustian bargain.
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