Envisioning 2.0

This article is part one of an ongoing series inspired by the Seattle Times special, “Suddenly Sick.” The Times’ series examines how the pharmaceutical industry promotes medications for a range of conditions, including hypertension and obesity. Click here to read “Suddenly Sick.”

Prescriptions, Promotion and Pills: Big Business Or Medical Progress?

In the first installment of the series, “Suddenly Sick,” Susan Kelleher and Duff Wilson of The Seattle Times wrote:

“You leave the [doctor’s] office . . . joining more than 40 percent of Americans who take one or more prescribed drugs daily in the effort to stave off more serious trouble. [However,] [y]ou are suddenly sick, simply because the definitions of disease have changed. And behind those changes, a Seattle Times examination has found, are the companies that make all those newly prescribed pills.”

Kelleher and Wilson’s complaint about the pharmaceutical industry’s marketing practices is an old one. For decades, critics have said drug companies spend too much time manufacturing medications we don’t need. They say that rather than directing resources toward developing drugs for life saving conditions like cancer, malaria and AIDs, the industry makes unneeded medications for preventable illnesses like high blood pressure.

Let’s pause for a moment and ask a few questions about the implications of Kelleher and Wilson’s statement for three areas of medicine: drug development, promotion and prescribing.

Drug Development

The pharmaceutical industry spends an average of $800 million to bring a drug to market. In recent years, many of these medications have been copies of pre-existing drugs or treatments for preventable diseases like hypertension, obesity and osteoporosis.

Key Questions: Is it a waste of resources to develop treatments for preventable conditions? What types of medications should industry develop? Should the drug industry reexamine its priorities?

Drug Promotion

Once the Food and Drug Administration approves a medication, pharmaceutical companies have a limited time to recoup their investment before the medication goes off patent. Partly because of this, drug firms spend millions of dollars educating physicians and the public about their products.

Key Questions: Is the patent system broken? Should drug companies refrain from promoting their products?

Treatment Guidelines and Prescribing Patterns

Government, medical associations, hospitals, physician groups, managed care organizations and others spend significant time and energy developing treatment guidelines. No guideline is considered credible unless its authors carefully evaluate the results of numerous clinical trials.

In addition, many physicians on guideline development panels have consulted with the pharmaceutical industry. The majority of well-regarded doctors believe that they have the ability to objectively evaluate the evidence and make recommendations that may greatly influence prescribing patterns.

Key Questions: If a medication is shown to provide better protection against heart attacks and strokes and happens to be a newer medication should it be used? Does the fact that a physician has consulted with a drug company forever taint his or her recommendations?

Discussion

All of these questions are very difficult to answer. (In fact, I’m hoping that the “wisdom of crowds” will provide some additional insight on this issue.) My point in raising these questions is to highlight the fact that are no purely right or wrong answers to these questions — only shades of grey.

For example, some physicians who spend many hours each day seeing patients who are obese, hypertensive and at high risk of having a heart attack or stroke will tell you that lifestyle modifications are largely ineffective. These doctors will argue that people won’t change their diet and they don’t like to exercise. If a pill will prevent a heart attack or stroke that’s wonderful. If it happens to be a new medication that’s fine too. In their view, that new lipid buster is a lifesaver, not an unnecessary expense.

In sum, there is a fine line between big business and medical progress. In this era of health savings accounts and tiered co-payments it will be up to the healthcare “consumer” to figure out where to draw it.

Next Up: The controversy over high blood pressure. What’s prompting changes in hypertension treatment — is it public health or profit?

This entry was posted on July 14, 2006 at 4:11 pm and is filed under Disease Mongering Or Saving Lives?. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.