Drugs, Devices & Doctors_NYT Paul Krugman
VERACARE
Promoting Openness, Full Disclosure, and Accountability
www.ahrp.org
FYI
New York Times columnist, Paul Krugman, got it right!
The real story behind the crisis at Merck, the Cleveland Clinic, and the
medical industrial complex as a whole "is bigger than either the company or
the clinic. It's the story of how growing conflicts of interest may be
distorting both medical research and health care in general."
"The economic logic of the medical-industrial complex is straightforward.
Prescription drugs and high-technology medical devices account for a growing
share of medical spending. Both are products that are expensive to develop
but relatively cheap to make. So the profit from each additional unit sold
is large, giving their makers a strong incentive to do whatever it takes to
persuade doctors and hospitals to choose their products."
Other examples of "economic logic" are the "screening" for illness
campaigns--which are nothing but market expansion schemes.
Take, Columbia University's TeenScreen--which is already operating at 460
locations in 44 states.
TeenScreen purports to be a suicide-prevention tool--however, there is no
scientifically valid screening tool for the prevention of suicide.
The truth is, TeenScreen is designed to expand the market for psychotropic
drugs by referring a flock of normal children for "mental health services."
The TeenScreen formula, a 14 item questionnaire whose vague and suggestive
questions, results in 30% to 50% of children / adolescents screened to be
declared "suicidal" and "depressed." This is shameless pathologizing
without a shred of scientific validity.
Since a survey in the Journal of the American Academy of Child & Adolescent
Psychiatry (2002) confirms that 91% of children referred for mental health
services are prescribed drugs--30% with therapy; 61% drugs alone; and only
9% are referred for psychotherapy alone--
TeenScreen is at its core a marketing tool devised for the purpose of
increasing the use of psychotropic drugs. Healthy children are being
transformed into drug consumers.
See a recent (Dec. 12) presentation at the American Public Health
Association: http://www.ahrp.org/ahrpspeaks/TeenScreen/index.php
Contact: Vera Hassner Sharav
212-595-8974
vera...@ahrp.org
THE NEW YORK TIMES
http://www.nytimes.com/
December 16, 2005
Op-Ed Columnist
Drugs, Devices and Doctors
By PAUL KRUGMAN
<http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/pau
lkrugman/index.html?inline=nyt-per>
Merck, the pharmaceutical giant, is under siege. And one side effect of that
siege is a public relations crisis for the Cleveland Clinic, a celebrated
hospital and health care organization.
But the real story is bigger than either the company or the clinic. It's the
story of how growing conflicts of interest may be distorting both medical
research and health care in general.
Merck stands accused of playing down evidence that Vioxx, a best-selling
painkiller until it was withdrawn last year, increases the risk of heart
attacks. The most recent accusation of obscuring the evidence came from The
New England Journal of Medicine, which discovered that the authors of a
Merck-supported paper published in the journal had removed data unfavorable
to Vioxx. The journal called on the authors to issue a correction.
Dr. Eric Topol, a famed cardiologist at the Cleveland Clinic, has been
warning about the dangers of Vioxx since 2001. In videotaped testimony at a
recent federal Vioxx trial (which ended in a mistrial), he accused Merck of
scientific misconduct, and also testified that Merck's former chairman had
called the chairman of the Cleveland Clinic to complain about his work - an
action Dr. Topol called "repulsive."
Two days after that testimony, according to Dr. Topol, he was told early in
the morning not to attend an 8 a.m. meeting of the clinic's board of
governors, because the position of chief academic officer, which gave him a
seat on the board, had been abolished. A clinic spokeswoman denied that the
abrupt elimination of this post had any link to his Vioxx testimony.
A few days later, The Wall Street Journal reported on a web of financial
connections between the Cleveland Clinic, its chief executive and AtriCure,
a company selling a medical device used in a surgical procedure promoted by
the clinic. Dr. Topol - whose demotion also cost him his seat on the
conflict-of-interest committee - was "among those who questioned the ties,"
the newspaper said.
O.K., it's sounding complicated. But the essence is simple: crucial
scientific research and crucial medical decisions have to be considered
suspect because of financial ties among medical companies, medical
researchers and health care providers.
That should come as no surprise. The past quarter-century has seen the
emergence of a vast medical-industrial complex, in which doctors, hospitals
and research institutions have deep financial links with drug companies and
equipment makers. Conflicts of interest aren't the exception - they're the
norm.
The economic logic of the medical-industrial complex is straightforward.
Prescription drugs and high-technology medical devices account for a growing
share of medical spending. Both are products that are expensive to develop
but relatively cheap to make. So the profit from each additional unit sold
is large, giving their makers a strong incentive to do whatever it takes to
persuade doctors and hospitals to choose their products.
The tools of persuasion go beyond hiring cheerleaders as sales
representatives. There are also financial inducements, sometimes disguised,
sometimes blatant. A few months ago, Reed Abelson of The New York Times
reported on a practice in which device makers give surgeons who are in a
position to choose their products (with others paying the cost) lucrative
consulting contracts, in some cases running to hundreds of thousands of
dollars a year.
Above all, the line between medical researcher and medical entrepreneur has
been blurred. In her book "The Truth About the Drug Companies," Marcia
Angell, a former editor of The New England Journal of Medicine, writes that
small companies founded by university researchers now "ring the major
academic research institutions ... hoping for lucrative deals with big drug
companies." Usually, she says, "both academic researchers and their
institutions own equity" in these companies, giving them a strong incentive
to make the big drug companies happy.
The point is that the whiff of corruption in our medical system isn't
emanating from a few bad apples. The whole system of incentives encourages
doctors and researchers to serve the interests of the medical industry.
The good news is that things don't have to be that way. Economic trends gave
rise to the medical-industrial complex, but only because those trends
interacted with bad policies, which can be fixed. In future columns I'll
talk about how serious health reform can reduce the conflicts of interest
that taint our current system.
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