Here’s some good, or at least promising news, as a recent WSJ Health Blog headline put it: “More Doctors Giving Pharma Sales Reps the Cold Shoulder”:
The number of physicians who were “rep-accessible,” defined as meeting with at least 70% of salespeople who come calling, dropped by 18% from last year, according to sales and marketing consultants ZS Associates.
In a report out today, the firm says 58% of prescribing doctors now fall into that rep-friendly category, down from 71% in the previous survey. The proportion of physicians who see fewer than 30% of reps who visit now sits at 9%, up from 6% in the last survey.
At the same time, it seems more are also questioning the corporate “disease care” dogma that more medicine is always better medicine. For instance, ABC News reports that the esteemed journal Archives of Internal Medicine has begun a regular feature spotlighting “treatments that have gone beyond their original purpose and expanded to the point where the risks of the treatment outweigh benefits.”
Treatments may come about to help a certain population, but when a medical treatment is overused in an otherwise healthy person, “There can only be harm,” [Dr. Deborah] Grady [co-author of AIM‘s first editorial on the subject] said. “We’d really like to bring attention to this.”
And Grady said that goes beyond doctors, to getting patients to question whether they need additional medical treatment.
Studies in the current issue look at potential risks of proton-pump inhibitors, which were originally designed for gastric reflux but now are used for conditions as mild as heartburn.
“They’re given for upset stomach, stuff that will be gone tomorrow, stuff that could be avoided by adopting a diet that doesn’t upset your stomach or give you heartburn,” Grady said.
Even so, there’s still a long way to go, as evidenced by Marcia Angell’s latest article on the subject, “Big Pharma, Bad Medicine”, which looks at how drug companies corrupt academic medicine in the course of pursuing their primary mission: to make money.
Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies – like other investor-owned businesses – are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.
This profound difference in missions is often deliberately obscured – by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.
We highly recommend this article, as well as Angell’s 2004 book The Truth About the Drug Companies. Give it a read.
That said, the problems in corporate medicine are not apt to go away until there is a general deepening and broadening of our understanding of illness and health. While the dominant, linear Newtonian model works fine with respect to monocausal conditions, it falls short when it comes to “enigmatic” illnesses such as fibromyaligia, chronic fatigue, various autoimmune and neurological disorders and the like. A more holistic approach is needed. To learn more, read Dr. Verigin’s article “A Biological Dentist’s Perspective on Living Systems” in Biosis 28.
Meantime, kudos to the Archives of Internal Medicine and to all those doctors who are learning how to just say “no.”