No,
this isn't another book about Americans popping too many
pills and paying exorbitant prices for them. Its far more
worrisome premise is summed up in the long subtitle: How
the Pharmaceutical Companies Distort Medical Knowledge,
Mislead Doctors, and Compromise Your Health. Author
John Abramson, MD, is troubled by the commercial influences
that pervade all aspects of American medical care. The
pharmaceutical industry's influence can be seen in everything
from the sponsoring of continuing medical education to
the latest treatment guidelines that make an ever-expanding
number of Americans candidates for life-long drug therapy.
A
Harvard Medical School faculty member, Dr. Abramson writes
that he thoroughly enjoyed practicing family medicine
for over 20 years. But he had become increasingly disturbed
by the new brand of medical consumerism, typified by the
middle-aged male patient who came in demanding an expensive,
widely advertised prescription drug (Celebrex). No amount
of explaining about cheaper, safer and equally effective
alternatives could change his patient's mind.
It
is not only his patients who get a skewed view of new
drugs, observed Dr. Abramson, his fellow physicians were
influenced by the same promotional campaigns, often masquerading
as education. Whereas taxpayers once funded most medical
research, the pharmaceutical industry now pays the lion's
share. By now, many Americans know that the pharmaceutical
industry has one of the highest profit margins of the
Fortune 500 companies. How many know that the industry
spends more money on marketing (from advertising to free
drug samples for doctors) than on research?
Dr.
Abramson left his practice to spend the next two and a
half years doing what most practicing doctors have little
time to do—“researching the research.” He found that drug
companies have been known to: design clinical trials in
such a way that ensures their products will come out on
top; withhold the trials that show negative results; focus
attention on the benefits while giving short shrift to
the harms; and ‘spin' equivocal results in a way that
puts their drugs in a favorable light.
What's
more, the people selected for clinical trials are often
unrepresentative of the majority for whom the drug will
ultimately be prescribed. Cancer drugs are offered as
an example. “Nearly two-thirds of all cancer patients
are 65 or older,” observes Dr. Abramson, “but only one-quarter
of the people in cancer studies have reached 65.” Many
of the articles published in medical journals, even the
most prestigious ones, he found, are little more than
infomercials for the drug.
In
time, Dr. Abramson began to detect the frequent use of
overblown statistics guaranteed to scare people into a
life-long drug regimen. Two years ago, The New England
Journal of Medicine published a study about a new, inexpensive
blood test that measures blood levels of inflammation
in the body called C-reactive protein, or CRP, which supposedly
can predict a person's risk of heart disease. The study
followed 28,000 women over eight years and found that
those with the highest CRP levels were more than twice
as likely to develop heart disease. The study's authors
concluded that identifying people with elevated CRP would
allow “optimal targeting of statin therapy.” In other
words, a way to identify future customers for cholesterol-lowering
drugs.
What's
wrong with this picture? asks Dr. Abramson after the largely
uncritical media picked up the CRP story and ran with
it as “ground-breaking” and “extremely important.” A closer
look at the statistics from this study showed that the
28,000 female participants were less than 55 years old
and healthy. Their risk of heart attack, stroke, etc.
was quite small. For “every 1000 women with the highest
CRP levels, there was only slightly more than one (1.3)
additional episode of cardiovascular disease each year
than among the 1000 women with the lowest CRP levels.”
In other words, the twice-as-likely-to-develop-heart-disease
statistic boiled down to a doubling of odds that were
tiny to begin with.
With
the relentless focus on drugs, Dr. Abramson suggests that
doctors and the general public tend to overlook the considerable
body of research showing that regular exercise, smoking
cessation, and a healthy diet trump nearly every medical
intervention as the best way to keep heart disease at
bay.
Americans
tend to have faith in the latest high-tech medical care,
but a large Medicare study challenged some common assumptions.
Areas of the country with higher concentrations of specialists
have both higher health care costs and worse health care
outcomes.
“The
public needs access to independent expert opinion that
can counterbalance the enormous influence that the medical
industry wields over our beliefs about the best approach
to health and medical care,” writes Dr. Abramson. (Full
disclosure: The Center for Medical Consumers is mentioned
twice in this book as one of the rare sources of unbiased
information.) A new national public body with the independence
and expertise of the Institute of Medicine , he suggests,
is the only way that will ever be accomplished.
--
Maryann
Napoli December 2004
