Wednesday, October 24, 2007

Bashing Head-to-Head Drug Trials--from a Conflicted Source

This post is thanks directly to Dr. Roy Poses's "Health Care Renewal" blog, and indirectly thanks to the Prescription Project whose "weekly reader" directed me to it.

Dr. Poses quotes from a New York Times op-ed (Oct. 18) by Peter Pitts, writing on behalf of the Center for Medicine in the Public Interest, which the paper identified as "a nonprofit organization that receives financing from the pharmaceutical industry." (Try to find something that they have printed or disseminated that is not favorable to the drug industry.) Left unsaid by the Times is the fact that Pitts is also a senior vice president for a PR firm that includes many pharmaceutical giants among its accounts.

Pitts is upset that the SCHIP bill (health insurance for children) may not be dead despite Congress's failure to override the Presidential veto. The bill has a lesser known provision that would create a Center for Comparative Effectiveness for Medicare. This Center would have a $300M budget to do what the popular parlance calls "head-to-head" trials of drugs to see whether expensive new drugs are truly better than older, cheaper drugs.

Pitts proceeds to give several reasons why comparative effectiveness research is really a rotten idea--the studies may be flawed; and we cannot trust the government to do them fairly, as Medicare has a vested interest in cutting costs and not in finding out which drug is truly best.

Poses then goes on to dismantle these arguments detail by detail, and to note what Pitts leaves unsaid--that the current system is that no such head-to-head trials are done, or if they are done, they are done on the company dime and are aimed at providing marketing advantage, not at getting the best scientific answer. It is a far stretch to imagine that Medicare's conflict of interest would be worse than the industry's.

Poses leaves out yet another argument against Pitts. Medicare is a government program. For all the flaws that this might give it, the bottom line is that it is of necessity fairly open and accountable. If Medicare manipulated studies to be sure that the cheapest drug "won" all the time, there is a pretty good chance that somebody would get wise and blow the whistle. By contrast, the drug companies own their research data as proprietary, and HOOKED recounts numerous instances where if those data don't support the company's marketing message, they never see the light of day--or do so only after somebody files a lawsuit and company documents become discoverable in court.

The shamelessness with which the industry continues to put forth its preferred message, despite all logic and science to the contrary, via its numerous paid minions, continues to astound.

1 comment:

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