Sunday, December 02, 2007

Pushing drugs

Two people I'd be happy to never see again: Robert Bazell and Robert Jarvik.

Bazell is the Chief Science and Health Correspondent on NBC Nightly News. He's a good reporter and no doubt means well, but his earnest nightly proclamations from the world of health research stand for everything I hate about American network news. Ten minutes of real news, ten minutes of Big Pharm ads, and ten minutes of Mr. Bazell feeding us the latest medical miracle: "A new study announced today in the New England Journal of Medicine shows that drinking 6 ounces of cucumber juice a day can reduce the incidence of psoriasis by two percent." OK, I made that up, but it sounds familiar, doesn't it? Maybe one out of five of Bazell's stories are as important as the least significant news story on BBC America. Part of this is surely the networks playing to their health-obsessed baby-boom audience. But the health obsession of baby boomers goes hand in hand with the billions of dollars Big Pharm spends nurturing that obsession. Robert Bazell is the face of the networks giving up on real news.

If you're an American and don't know who Dr. Robert Jarvik is you've been living under a rock. He's surely the hottest property of the Big Pharm marketers. Just look at all those full-page spreads in the newspapers. "Inventor of the Jarvik artificial heart and Lipitor user." His smug face is enough to give me a heart attack. Big headline: "Lipitor reduces risk of heart attack by 36 percent." Wow! Smaller print: "That means in a large clinical study, 3 percent of [high risk] patients taking a sugar pill or placebo had a heart attack compared to 2 percent of patients taking Lipitor."

In his book, Overdosed America, Dr. John Abramson of Harvard Medical School looks carefully at the studies cited as evidence for the effectiveness of cholesterol-lowering meds such as Lipitor (statins). His conclusion: The drugs are vastly overprescribed, to no one's benefit but Big Pharm. Which is where Dr. Jarvik comes in. If Mr. Artificial Heart flashes his po mug as a stamp or approval, then everyone who reads the newspaper or watches TV should rush right out and ask their doctor for Lipitor.

Don't get me wrong. I'm not anti drugs or Big Pharm. I was supremely glad for antibiotics last year when I got Lyme disease. If I had AIDs or if I were chronically depressed, would I be on drugs? You bet. Scientific drug development has transformed civilization, increased longevity and quality of life. Dozens of mortal diseases have been checked by vaccines and drug therapy. It's not drugs but drug marketing that makes me and lots of other folks uneasy. Every time I see an animated toenail gremlin or talking blob of green mucus I lose a bit more respect for whatever authentic integrity the drug industry might have.

Do prescription drugs really need to be called Lyrica and Celebrex? What are they selling? The elixir of bliss? Do the drug companies need to flood the media with sunshine, blue skies, and beautiful people standing in fields of daisies to create a market for prescription products? As Marcia Angell, a former editor-in-chief of the New England Journal of Medicine, writes: "Truly good drugs don't have to be promoted. A genuinely important new drug...sells itself."

Why is it that every Big Pharm sales rep I see entering our local medical center is young, attractive, and perfectly attired in dark, professional and -- yes -- sexy attire, both men and women? In a review of three anti-drug marketing books in the current New York Review of Books, Frederick Crews talks of how the big drug companies "insidiously colonize both our doctors' minds and our own." What do the vast sums spent on colonization -- more than on research and development! -- do to the cost of health care in America? What does the excessive use of powerful drugs do to the overall health of patients? The Boston University Medical Center has just placed restrictions on drug rep visits, and the Massachusetts legislature is considering rules requiring doctors to report any gifts worth over $25. Doctors and patients are getting fed up. Expect to see national restrictions soon.

In last Sunday's New York Times Magazine, Dr. Daniel Carlat, a psychiatrist, wrote of his recruitment by a drug company to educate other doctors about that firm's antidepressant drug. It was a lucrative role, which he rationalized on the basis of marginal data. It was only with time that he realized that he had been bought. When he started giving his audience of physicians the whole story he was dumped by his minders. One reads this sort of thing with increasing frequency.

And yes, I read the other side too, such as Eli Lilly CEO Sidney Taurel's ringing endorsement of the industry's commitment to accurate information in last Tuesday's Wall Street Journal.

We're all in this together, patients and doctors, and we rely on each other. Patients especially want to know that their doctors are well informed of the pros and cons of every therapy, and have no vested interest in any particular therapy. Doctors shouldn't have to deal with patients demanding unnecessary drugs they have seen shilled in the media. Who is going to figure out a way to get accurate information to doctors and patients while keeping the excesses of drug companies in check? There are more Big Pharm lobbyists in Washington than there are legislators. As the distinguished psychiatrist David Healy has noted, Big Pharm doesn't just bend the rules, it buys the rulebook.

I have tremendous respect for my own doctor, and I am confident there are countless other physicians just like him who want nothing but the best for their patients. It is only from them, it seems to me, that real reform can come. They must collectively purge the most egregious marketing ploys from the health care system, and shame the drug companies into responsible service to the common good.

As I wrote here once before: The beautiful thing about science is that it has been relatively immune to influence by religion, politics, ethnicity, and the other forces that divide us. It's a shame that our confidence in one of the most successful branches of science is eroded by greed.

Further Reading

Marcia Angell, The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Angell is a former editor-in-chief of the New England Journal of Medicine.

Jerry Avorn, Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs. Avorn is a professor at the Harvard Medical School.

Jerome P. Kassirer, On the Take: How America's Complicity With Big Business Can Endanger Your Health. Kassirer is another former editor of the New England Journal of Medicine.

John Abramson, Overdosed America: The Broken Promise of American Medicine. Abramson is a professor at the Harvard Medical School.

Discuss this essay and more over on the Science Musings Blog.