Good for Business, Bad for Patients?

Jan. 30, 2009 — -- It's perfect. Pfizer buys Wyeth's pipeline, the behemoth marketing power of Pfizer gets leveraged, the work force gets consolidated and the $22 billion borrowed is read as a sign that banks are willing to lend again.

Well, not quite perfect but pretty darned good.

The problem is: pretty darned good for whom? Both Pfizer and Wyeth are attending to their primary responsibility: maximizing profits and delivering them to shareholders. Improving Americans' health most effectively and efficiently is not their job, but convincing us all -- including doctors -- that it is, is.

We desperately need to find a way to contain health care costs and at the same time improve access. Seems impossible, but the almost unimaginable level of dysfunction in American health care actually creates enormous opportunity.

It's hard to believe that despite spending twice as much per person as the other industrialized countries, Americans live an average of 1½ years less in good health. And if the rate of potentially preventable deaths in the United States were declining as quickly as it is in Austria, Ireland and Norway -- three countries that lead in this respect, and each spend about half as much per person on health care as the United States does -- 100,000 fewer Americans would be dying each year.

The core problem with American medicine isn't really access or cost. It's that medical knowledge itself has been turned into a commodity, produced and disseminated with the primary goal of optimizing profits rather than health. Eighty-five percent of clinical trials are now commercially funded, and the odds are four to five times greater that the commercially funded trials will conclude that the sponsor's drug is the treatment of choice compared with noncommercially funded trials of exactly the same drugs, according to a lecture given at Harvard Medical School in October by Dr. Catherine D. DeAngelis, the editor in chief of the Journal of the American Medical Association.

That's just the beginning.

Those studies are then bundled into review articles (often sponsored by the drug maker); presented at continuing medical education courses that are funded directly or indirectly by the drug maker; supported by "key opinion leaders," recognized experts who happen to be getting paid by the drug maker; incorporated into guidelines -- the majority of expert authors having financial ties to one or more of the drug companies making a drug being considered in the guidelines; and, of course, touted by the drug reps lining up to get some face time with the doctors, who -- according to the Pharmaceutical Research and Manufacturers of America's research -- overwhelmingly find the information delivered by the reps up to date, useful and reliable.