Monday, July 6, 2009

New Work on the History of Pharma Influence

Exactly how, and over what period of time, did the pharmaceutical industry get its hooks so deep into the medical profession in the US? I found the absence of a good historical account of Pharma influence one of the major handicaps as I wrote HOOKED. I tried my hand at constructing the best historical background account that I could using secondary sources; but I was not able to do the archival research that is needed to fully flesh out the story. Now, Jeremy Greene at Harvard, whose earlier work I had referred to in HOOKED, has produced another essay that fills in some gaps for the post-WWII period.

I propose, with broad brushstrokes in HOOKED, that the period of roughly 1945-1960 was characterized by an "alignment of the planets" that shaped the relations between medicine and Pharma up to the present time:
  • A huge increase in the number of new, mostly useful drugs
  • The AMA's retreat from its older stance of providing scientific analyses of new drugs for physicians
  • Academic medicine's abandonment of the continuing education of practitioners to industry
Basically these events left both a huge need and a huge vacuum in the practitioners' education on new drugs, which the industry was happy to rush to fill--and we have not succeeded in dislodging it since.

Greene and Podolsky's new essay adds detail to this "alignment" account without calling any of its basic elements into question, so far as I can tell. They explain more about the careers and beliefs of the first generation of academic physicians to challenge the drug industry's influence over medical education--most of whom represented either the new infectious disease movement or the new clinical pharmacology movement, both of which, had there been a term in use at that time such as "evidence-based medicine," would have claimed to be part of that. Arrayed against them, besides the actual leaders of the industry itself, were some other key physician leaders who were financially committed either to medical publishing or to medical marketing and advertising--and to them, the issue was simply one of modernization. The advertising firms had invented effective new ways to get information about new drugs quickly into the hands of practitioners; academic medicine should be cheering this discovery rather than quibbling about the details. What would count as "modern" medicine was effectively in dispute in this debate. Finally they explore the anbiguous role of the AMA, on the one hand trying to hang onto as much control as it could over the accreditation of continuing medical education, yet eagerly allowing the industry to take over CME funding.

Greene and Podolsky mention in passing one intriguing figure of the day, Hopkins pharmacologist Louis Lasagna. Initially a major critic of industry influence, Lasagna ended up largely switching sides and becoming a strong advocate for the industry perspective, even to the extent of becoming what many would deride as a "shill." A detailed study of Lasagna's conversion, they suggest, would be of considerable historical interest.

Greene JA, Podolsky SH. Keeping modern in medicine: pharmaceutical promotion and physician education in postwar America. Bulletin of the History of Medicine 83:331-377, Summer 2009.

No comments: