Tainted intentions from the health care industry: part one

A doctor-patient relationship is one of the most vital relationships many people will have in their lifetime. Patients trust their physicians to recommend the safest and most effective forms of treatment for illnesses ranging from the common cold to life-threatening cancer. Patients expect their physicians to give them unbiased advice based on years of experience and each person's individual case history.

Are these expectations being met?

Over the past few years, pharmaceutical companies have been experiencing an economic boon that has not been seen in any other industry. Companies are earning and spending billions of dollars each year on prescription drug advertising designed to convince physicians that their drug is the best drug. Advertisements in medical journals, drug company-sponsored galas, and ,even personal sales visits that can earn physicians thousands of dollars a year are all regular occurrences.

For example, a small-town doctor spent a weekend in New York City at a seminar sponsored by Pfizer, the makers of sildenafil (Viagra[R]). He walked away with more than $10,000 dollars worth of "freebies," including an all-expenses-paid trip to a resort in Florida, dinner cruises, hockey tickets, a ski trip for his family, and free computer equipment. Other physicians accepted free massages, food, and portraits. A company that manufactures an antacid drug was giving away fire extinguishers.

"It's very tempting, and they just keep anteing it up," said one physician, "I feel in some ways it is kind of like bribery."

Individual physicians, however, are not the only ones feeling tempted to receive money offered by the drug companies. The New England Journal of Medicine recently relaxed its strict conflict-of-interest policy because of a shortage of publishable authors who had no ties to the pharmaceutical industry. Since 1990, the Journal's rule was that no one could publish an article who had any financial interest in a company that made a product discussed in the article or in one of the product's competitors. Now the Journal restricts authors who have a "significant" stake in a product's interest. Payments over $10,000 are considered significant. In 2000, the Journal admitted that it had violated its own policy 19 times in the previous three years.

Some pharmaceutical companies have gone as far as to write articles themselves, and then search for a reputable doctor to attach his or her own name as the author.

"Some of us believe that the present system [of ghostwriting] is approaching a high-class form of prostitution," said Fuller Torrey, executive director of the Stanley Foundation Research Programs in Bethesda, Maryland.

What of the drags themselves? A perfect drag that is free of adverse effects does not exist. On the contrary, evidence suggests that many potentially life-threatening drags are being prescribed in great numbers each day. A study published in the New England Journal of Medicine shows that complications from taking older anti-inflammatory drugs--such as rofecoxib (Vioxx[R]) and valdecoxib (Bextra[R])--results in hospitalization of more than 107,000 patients each year in America, whereas ulcer complications kill approximately 16,500 patients each year. When faced with the decision regarding the lucrative prescription of a potentially harmful drug or a less threatening alternative therapy featuring a dietary supplement or vitamin, how many physicians would turn their backs on the pharmaceutical "gift horse" and suggest a supplement?

There is a widely held misconception that the Food and Drag Administration (FDA) conducts the actual tests on prospective drugs; however, it does not. To determine safety of a particular drug, the FDA simply reviews the literature and trial data from the pharmaceutical company that manufactures the medication. In essence, the government is depending on evidence provided by the very people who are pushing to get the drug approved. The terrifying part of this ordeal is that no one can ever be 100 percent certain of the accuracy of the studies, but approval is not the only frightening part of the process.

Once a drug is approved for general use, a pharmaceutical company can make any claim it wishes in regard to the effectiveness and usefulness of its product. Direct-to-consumer pharmaceutical ads have been] saturating television and print media for the past several years. Each ad is full of images and claims that are remarkably similar to the "snake oil" panaceas of the early 20th century. "With this one small pill," they say, "all of your problems with drift harmlessly away."

Even if a consumer or special interest group challenges a drug's safety, the process of removing that drag from the market is dangerously slow. Patients--most likely misled by a physician on the pharmaceuticals payroll--could take the drug, completely unaware of the deadly consequences quietly being discussed by the manufacturer and the government. If a drug is found to be sufficiently dangerous, it is pulled quickly and silently off of the shelves and the pharmaceutical company will most likely pay a small fine for killing innocent people. Unfortunately, no accurate records of accidental deaths caused by faulty drags exist.

Granted, not every ailment can be treated with a supplement, and the FDA currently does not review the potential, benefits of certain alternative therapies, but how many people are suffering needlessly from the adverse effects, of drugs because no research is being done to come up with a better solution? Compare the number of injuries from prescribed drugs to the number of injuries atrributed to herbs and vitamins, and the current' system appears even more ludicrous.

Physicians are human and therefore are prone to temptation. There are those physicians who do not take money from any pharmaceutical company or other outside interests and who are genuinely concerned for their patients' health. In order to reform the current system in which the prescribing of a certain drag constitutes a second income, however, more of the honest physicians will have to stand up and resoundingly reject any and all forms of bias and ensure that the doctor-patient relationship is not being abused for profit.

Part two of this editorial will appear in Nutrition Health Review issue #85.

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