Pharmaceutical industry influence on American medical practice and patient care

¶ … Overdosed America by Jay Abramson

Abramson, Jay. (2004). Overdosed America. New York: HarperCollins.

Read this book before you go to the doctor!

Key assumptions deflated regarding modern medicine -- not everything you read in the media with a doctor's name after it is objective!

Tests unlikely to improve patient care are being routinely ordered, as the result of insistent but ill-informed patient demands. Influence of patient-targeted advertising by big pharmaceutical companies.

Expensive drugs that had not been shown to be any more effective or safer than the older drugs they were replacing are being routinely prescribed

Condemnation of 'infomercials' masquerading as health information. Infomercials rather than doctors inform patients today.

Chapter 2 Medical Journals

The politics of spin -- influence of money upon what gets published and publicized, although such journals should provide unbiased evidence, and be the mouthpiece of respected professionals.

Following the money -- many medical journals publish studies that receive funding even a covert fashion from the pharmaceutical industries they purporting to study

Use of these journals for marketing purposes, not to draw an objective conclusion about the data or to promote patient health

III. Chapter 3: Celebrex and Vioxx case studies

Marketing to doctors

More money to go around as new drugs are developed and have yet to become cheaper and generic, even if new drugs do same thing or are more dangerous, these new drugs are marketed as better and different

VII. Chapter 7: The Commercial Takeover of American Medicine

Lack of empowered regulatory agencies

FDA subject to political pressures from corporations and interest groups

Commercially sponsored medical education -- get the doctors while they're young!

1. Funding medical education -- receiving corporate sponsorship and funds comes at a price to doctor objectivity and patient health.

VIII. Chapter 8: The Snake and Staff -- Duping American Doctors

Wooing doctors with 'freebies' -- drug reps give free dinners, meals, and food to doctor's office, and office supplies with drug names

In reality, drug companies have no more responsibility to oversee the public's health than the fast-food industry has to oversee the public's diet -- both corporations in the business of making money, not saving person's lives. But drug companies have more legitimacy in eyes of the public

IX. Chapter 9 Cholesterol Guidelines

Cholesterol guidelines not absolute as may seem -- subject to political and business pressure to alter guidelines

Guidelines change with invention of medicines to treat high cholesterol

Cholesterol drugs expensive, often unnecessary, but have given great profits for drug companies!

X. Chapter 10: Direct to Consumer Advertising

Television

Television advertising has caused a rift in traditional doctor-patient relationship.

Patients arriving for doctor visits with a firm, fixed idea of outcome -- prescribe me the drug because I saw it on television! Encourage consumers to think buying drug like buying soap.

End of expectation that individual doctor knows best and best medical care emerges from open discussion of patient symptoms, concerns, and exam and consideration of the options, some of which may involve lifestyle changes not drugs

Radio

1. Even in car, hear about medical miracles that can change your life. Unending assault on consumer ears through various media.

Public Relations

There are financial ties between many of the supposedly most trusted medical experts and the medical industry

Medical 'news' or advertising masquerading as news

Studies on real news shows, funded by drug companies are presented as objective

Inadequate medical coverage and research on news -- medical news not hard news so less fact-checking

Lazy reporters -- accept biased reports as facts

XI. Chapter 11: Follow the Money -- Supply-side medical care

More care and more intervention means more money, but is not necessarily better medicine and better for the patient

Supply-side medicine means medicine has primary interest of improving financial health of hospital

XII. Chapter 12: Biomedicine limits

A. Scandal of using technology simply because 'you can' -- near-automatic use of medical technologies, such as cardiac catheterization, less because they are needed than because they are available

XIII. Chapter 13: What research shows about staying healthy.

Case study of the selling of Fosomax

1.Studies in respected peer-reviewed medical Journal of American Medicine promise the moon -- say Fosamax works

2. Randomized clinical trials of Fosamax published in medical journals show dramatic reductions in the relative risk of hip fracture for women with osteoporosis. JAMA in 1998 says women with an average age of 68 and a T score of - 2.5 or less (bone density score that means osteoporosis) who took Fosamax for four years were 56% less likely to suffer a hip fracture than women in the control group.

How many hip fractures were really prevented? With no drug therapy at all, women with osteoporosis had a 99.5% chance of making it through each year without a hip fracture

Creation' of illness in media, medical journals, and advertising

Also, osteoporosis drugs work on outer part of the bone, the cortical bone. This increases the score on bone density test but does not necessarily contribute proportionately to fracture resistance. Statistics look good, but drugs don't change much.

Prevention better

Walking statistically better way of reducing hip fractures

XIV. Chapter 14: Solutions

Value of preventative medicine -- medicine should not be a commodity

System not working -- currently costs America 500 billion a year

Remember that America spends more on medicine than any other industrialized nation and still not healthiest and not every American is covered by insurance

America spends more on high-tech neonatology than other Western countries but has a higher infant-mortality rate because of inattention to low-tech prenatal care.

Gap is widening between the scientific evidence that impartial experts

Paxil example -- based on nine clinical studies on adolescents

No more effective than placebos

Increases the frequency suicidal thoughts and attempts)

Solution of drug company

Created task force of the American College of Neuropsychopharmacolgy which approved drug under review although 9 of the 10 task force members had financial ties to pharmaceutical industry

FDA epidemiologist in charge of analyzing all the antidepressant studies involving children concluded Paxil dangerous but barred from testifying at government hearing

Use of preventative, non-drug methods to treat depression like physical exercise, therapy better, especially in young people

Endovascular Technologies example (subsidiary of Guidant, the company that manufactures defibrillators)

Manufactured a $10,000 device to repair aortic aneurysms -- malfunctioned in a third of the 7600 patients in study

Company underreported number to FDA, and this never checked. Guidant later disclosed 2628 new malfunctions, resulting in 12 deaths.

Company still in business although $92 million poorer after criminal and civil payments to victims and regulatory officials.

Conclusion

Stay healthy! Preventative medicine is best

Need to return to relationship of trust between doctors and patients.

Media and money should not control quality of medicine