Case Study Of Pill Pushing: The Cancer Of The Healthcare System
Taylor Thomas
Pill Pushing: The Cancer of the Healthcare System The sorry state of our health care system is something most people today recognize. However, it can be difficult to see the fundamental flaws through the veil established through the haze of politics. We must realize that the core issues are much bigger than left versus right. The dire consequences of this system can be seen in many areas. At 15% of our GDP, we spend more on healthcare than any other country, yet we have the lowest life expectancy rate and one of the highest infant mortality rates out of the 12 most developed nations (Abramson 85). Today, we have a health care industry that profits more when people are sick than when they are healthy. The business model of the industry doesn’t focus on finding new cures and healing, but on creating paying customers. The pharmaceutical industry’s scope of power is huge. Their influence stretches into many different areas. One of the fundamental problems is their influence on our government. Big Pharma spends more on lobbying our leaders than any other industry except one. From 1997 to 2000, the industry spent $734M lobbying Congress and the executive branch (Barlett 69). They also contribute massive amounts of money to various political campaigns. As a matter of fact, in the last …show more content…
fifteen years, they donated more to political campaigns than commercial banks, energy, and big tobacco (69). To make matters worse, the American Medical Association uses many of the same lobbyists as the pharmaceutical companies. “According to the Lobbying Disclosure Act database, one of the American Medical Associations ' top lobbying firms, the McManus Group, also lobbies for PhRMA, Eli Lilly & Company, Merck, and Pfizer” ("The AMA 's Lobbyists & Political Contributions" 1). However, the political manipulation on behalf of the major drug companies goes much further than corporate lobbying and campaign donations. For example, take a look at the Medicare Prescription Drug Improvement Act of 2008. The act was the first ever medicare prescription drug benefit, giving over half a trillion dollars in tax payer subsidies to the big pharmaceutical companies. The act also blocked all imports of low-cost drugs from Canada, which was a top priority for our domestic pharmaceutical companies. The man responsible for the bill was Thomas Scully, the president of the federal centers for medicare and medicaid services. Before that position, he was the president of the Federation of American Hospitals, a trade association of for-profit hospitals, which depended heavily on federal tax dollars despite its “dedication to a market-driven philosophy” (Barlett 70). The act Scully crafted threw billions of tax dollars at private corporations to fein the functionality of the market system. What makes the situation especially sickening is that during the process of passing the act, Scully was in the middle of working out a private negotiation to go back to work for the very same industry that was benefiting from the bill he was overseeing (70). To maximize their profits, the major drug companies go beyond politics, stretching their reign of influence into the education of our doctors. The pharmaceutical industry supports half of the cost of continuing medical education (CME) in the US (Brody 451). And for the producers of these drugs, that investment definitely pays off. “It has been estimated that for every $1.00 the industry invests in CME or similar meetings, it reaps $3.56 in increased sales” (454). The Accreditation Council for Continuing Medical Education (ACCME) is responsible for deciding which programs doctors can receive CME credit hours from. In an attempt to prevent corporate influence and bias, the ACCME has strict set of guidelines that it holds its members to. They try to accomplish this “by requiring the disclosure of the commercial ties of any speakers, and the independence of the group that selects the topics and content for the meeting from industry funding” (455). However, certain organizations like the MECC, which derives most of its profits from the pharmaceutical industry, are still allowed to decide which of their sponsored meetings receive CME credit instead of being reviewed by an organization with less of a dependency on the industry. (455). One of the reasons why the pharmaceutical industry is able to control so much of the content in medical education is that they fund most of the clinical trials that provide the ‘evidence’ used in the continuing education programs (455). To make matters worse, many of the clinical trials are riddled with chicanery. A paper was published in 2000 that exposed evidence of industry controlled trial design, analysis, and publication. “Industry control was manifested in several ways: decisions on funding clinical studies was made by marketing departments based on expected impact on sales; companies designed studies to produce desired results; data were stored by the company, and investigators worked only with data selected by the company; reports were ghost written by company personnel while listing investigators as authors; and companies delayed or prevented publication of results unfavorable to a product” (Sade 399). There are many instances of this kind deceit in the industry. For example, a heated debate exploded in 1998 over the safety of calcium channel antagonists after many of the researchers and clinicians who wrote the literature behind the drugs were found to have had financial ties to the drug manufacturers (399). Another instance of fraudulent research practice was exposed in the 2001 cholesterol guidelines, when 90% of the panelists for statin drugs also had financial ties to the drug producers (Abramson 121). If the manipulation of the information behind these drugs stretches all the way back to research and development, one must question the true efficacy of the pills pushed by the industry they are a part of, and the motivation behind the doctors to prescribe such drugs to the general public. The relationship between the physician and the pharmaceutical industry is something to keep a watchful eye on.
Although the physician may not recognize how the bottom line of the drug industry impacts the way he carries out his line of work, the influence the industry has on our medical system is monumental. The practice of ‘ghost writing’ is a great example of this. Ghost writing is when a drug company writes an article to promote a product or commercial message and pays an academic physician to attach his name to it. The industry-written article is then published in a medical journal with “no evidence of industry authorship” (Brody 459). In the words of Carl
Elliot:
Most of the people involved in these operations do not see any harm in taking a piece of the industry money for themselves. The academic researcher says: what’s the harm if I take money for signing onto a MECC-produced editorial as long as I agree with everything that is in it? The doctor says: what’s the harm in attending an industry-funded symposium in Boca Raton as long as I look at the presentations with a skeptical eye? The department head says: what’s wrong with taking money from Janssen or Merck to fund our Grand Rounds program if it means we can bring in more high-profile speakers? The journal editor says: what’s wrong with publishing an industry-funded editorial or review article as long as it gets appropriate peer review? The ethicist says: what’s wrong with funding our centers with industry money as long as the gifts are unrestricted and the funders are not issuing any orders? But it is only when all these cogs click together that the machinery is put into motion (Brody 455).
The physician-industry relationship is growing tighter every day. A study published by the New England Journal of Medicine showed that 94% of physicians reported having some kind of relationship with the drug companies. Most of the time, this manifested in free food and drug samples. However, some doctors also reported having financial ties to the industry. In fact, 35% of the respondents were reimbursed by the drug companies for CME or other types of professional meetings. Even worse, 28% reported to have been paid by the companies to consult, give medical lectures, or enroll patients in trials (Campbell). The influence drug companies have on the prescribing practices of our doctors is quite evident. “A broad investigation of over 500 previously published studies found that physician interactions with drug representatives were frequent and were associated with requests for additions to the hospital formulary and changes in physicians’ prescribing practices” (Sade 399). Even though it is nearly impossible to design a study to prove that a single factor can lead a doctor to write a particular prescription, studies published in the 1980s linked the content of CME meetings to commercial sponsorship influence. The studies showed “that later prescribing by attendees was likely to favor the products of the CME commercial sponsor” (Brody 455). Unfortunately, industry influence and manipulation can be traced all the way back to research and development. There is a lot of evidence that suggests that pharmaceutical companies design clinical trials to make sure their drugs come out on top, often spinning trial results and withholding negative outcomes. Industry influence is especially evident in that a trial sponsored by a drug company is 3.6 times more likely to reach an outcome that promotes the sale of the drug than in a neutral trial (Bekelman). There are a number of ways in which a drug company can manipulate clinical trials. In one form of manipulation, the people the companies select for clinical trials are often unrepresentative of the kinds of people the drug will be prescribed to. For example, “Nearly two-thirds of all cancer patients are 65 or older, but only one-quarter of the people in cancer studies have reached 65” (Abramson 104). Before 1980, researchers frowned upon industry support and most of the clinical studies were publicly funded. However, medical studies are quickly becoming overtaken by the industry. Today, three quarters of the studies published in the top three medical journals are funded by the pharmaceutical industry (Abramson 121). The pharmaceutical industry is becoming a dominating force of influence in our modern healthcare system. The manipulation they employ in their fight to expand their bottom line is reshaping the entire structure of the medical establishment in ways that must be addressed. After all, “The drug companies have no more responsibility to oversee the public 's health than the fast-food industry has to oversee the public 's diet” (Abramson 243). We cannot continue to let a system thrive that focuses more on pill pushing than healing.
Annotated Works Cited
Abramson, John. Overdosed America: The Broken Promise of American Medicine. NY: HarperCollins, 2004. Print. This book provides many examples that show how the pharmaceutical industry has misled doctors and the general public in an attempt to sell more drugs.
Barlett, Donald L., and B. Steele. James. Critical Condition: How Health Care in America Became Big Business. New York: Random House Large Print, 2004. Print. This book includes the statistics used to show the vast amount of money the industry spends on lobbying.
Bekelman JE, Li Y, Gross CP. “Scope and Impact of Financial Conflicts of Interest in Biomedical Research: A Systematic Review”. JAMA (2003): 454–465. Journal of the American Medical Association. American Medical Association, 22 Jan. 2003. Web. This article shows that a research trial sponsored by the industry is more than 3.6 times more likely than a neutral trial to reach conclusions favorable to sales of the drug.
Brody, Howard. "Pharmaceutical Industry Financial Support for Medical Education: Benefit, or Undue Influence?" Journal of Law, Medicine & Ethics (2009): 451-60. Print. This article outlines our modern system of continuing medical education and provides evidence highlighting the core problems with drug industry funded CME programs.
Campbell, E. G., R. L. Gruen, J. Mountford, L. G. Miller, P. D. Cleary, and D. Blumenthal. "A National Survey of Physician-Industry Relationships." New England Journal of Medicine 356.17 (2007): 1742-750. New England Journal of Medicine. Massachusetts Medical Society, 26 Apr. 2007. Web. 5 Nov. 2012. This survey provides the evidence used to outline the financial relationship between the industry and the physician.
Sade, Robert M. "Dangerous Liaisons? Industry Relations with Health Professionals." The Journal of Law, Medicine & Ethics 37.3 (2009): 398-400. Print. This article is used to show the ill effects of industry influence on patient care. It gives evidence exposing industry control in trial design, data analysis, and publication.
"The AMA 's Lobbyists & Political Contributions." Political Correction. Media Matters Action Network, 11 June 2009. Web. 5 Nov. 2012. This website outlines political campaign donations and shows how the American Medical Association use the same lobbyists as the big pharmaceutical companies.
Pill Pushing: The Cancer of the Healthcare System The sorry state of our health care system is something most people today recognize. However, it can be difficult to see the fundamental flaws through the veil established through the haze of politics. We must realize that the core issues are much bigger than left versus right. The dire consequences of this system can be seen in many areas. At 15% of our GDP, we spend more on healthcare than any other country, yet we have the lowest life expectancy rate and one of the highest infant mortality rates out of the 12 most developed nations (Abramson 85). Today, we have a health care industry that profits more when people are sick than when they are healthy. The business model of the industry doesn’t focus on finding new cures and healing, but on creating paying customers. The pharmaceutical industry’s scope of power is huge. Their influence stretches into many different areas. One of the fundamental problems is their influence on our government. Big Pharma spends more on lobbying our leaders than any other industry except one. From 1997 to 2000, the industry spent $734M lobbying Congress and the executive branch (Barlett 69). They also contribute massive amounts of money to various political campaigns. As a matter of fact, in the last …show more content…
fifteen years, they donated more to political campaigns than commercial banks, energy, and big tobacco (69). To make matters worse, the American Medical Association uses many of the same lobbyists as the pharmaceutical companies. “According to the Lobbying Disclosure Act database, one of the American Medical Associations ' top lobbying firms, the McManus Group, also lobbies for PhRMA, Eli Lilly & Company, Merck, and Pfizer” ("The AMA 's Lobbyists & Political Contributions" 1). However, the political manipulation on behalf of the major drug companies goes much further than corporate lobbying and campaign donations. For example, take a look at the Medicare Prescription Drug Improvement Act of 2008. The act was the first ever medicare prescription drug benefit, giving over half a trillion dollars in tax payer subsidies to the big pharmaceutical companies. The act also blocked all imports of low-cost drugs from Canada, which was a top priority for our domestic pharmaceutical companies. The man responsible for the bill was Thomas Scully, the president of the federal centers for medicare and medicaid services. Before that position, he was the president of the Federation of American Hospitals, a trade association of for-profit hospitals, which depended heavily on federal tax dollars despite its “dedication to a market-driven philosophy” (Barlett 70). The act Scully crafted threw billions of tax dollars at private corporations to fein the functionality of the market system. What makes the situation especially sickening is that during the process of passing the act, Scully was in the middle of working out a private negotiation to go back to work for the very same industry that was benefiting from the bill he was overseeing (70). To maximize their profits, the major drug companies go beyond politics, stretching their reign of influence into the education of our doctors. The pharmaceutical industry supports half of the cost of continuing medical education (CME) in the US (Brody 451). And for the producers of these drugs, that investment definitely pays off. “It has been estimated that for every $1.00 the industry invests in CME or similar meetings, it reaps $3.56 in increased sales” (454). The Accreditation Council for Continuing Medical Education (ACCME) is responsible for deciding which programs doctors can receive CME credit hours from. In an attempt to prevent corporate influence and bias, the ACCME has strict set of guidelines that it holds its members to. They try to accomplish this “by requiring the disclosure of the commercial ties of any speakers, and the independence of the group that selects the topics and content for the meeting from industry funding” (455). However, certain organizations like the MECC, which derives most of its profits from the pharmaceutical industry, are still allowed to decide which of their sponsored meetings receive CME credit instead of being reviewed by an organization with less of a dependency on the industry. (455). One of the reasons why the pharmaceutical industry is able to control so much of the content in medical education is that they fund most of the clinical trials that provide the ‘evidence’ used in the continuing education programs (455). To make matters worse, many of the clinical trials are riddled with chicanery. A paper was published in 2000 that exposed evidence of industry controlled trial design, analysis, and publication. “Industry control was manifested in several ways: decisions on funding clinical studies was made by marketing departments based on expected impact on sales; companies designed studies to produce desired results; data were stored by the company, and investigators worked only with data selected by the company; reports were ghost written by company personnel while listing investigators as authors; and companies delayed or prevented publication of results unfavorable to a product” (Sade 399). There are many instances of this kind deceit in the industry. For example, a heated debate exploded in 1998 over the safety of calcium channel antagonists after many of the researchers and clinicians who wrote the literature behind the drugs were found to have had financial ties to the drug manufacturers (399). Another instance of fraudulent research practice was exposed in the 2001 cholesterol guidelines, when 90% of the panelists for statin drugs also had financial ties to the drug producers (Abramson 121). If the manipulation of the information behind these drugs stretches all the way back to research and development, one must question the true efficacy of the pills pushed by the industry they are a part of, and the motivation behind the doctors to prescribe such drugs to the general public. The relationship between the physician and the pharmaceutical industry is something to keep a watchful eye on.
Although the physician may not recognize how the bottom line of the drug industry impacts the way he carries out his line of work, the influence the industry has on our medical system is monumental. The practice of ‘ghost writing’ is a great example of this. Ghost writing is when a drug company writes an article to promote a product or commercial message and pays an academic physician to attach his name to it. The industry-written article is then published in a medical journal with “no evidence of industry authorship” (Brody 459). In the words of Carl
Elliot:
Most of the people involved in these operations do not see any harm in taking a piece of the industry money for themselves. The academic researcher says: what’s the harm if I take money for signing onto a MECC-produced editorial as long as I agree with everything that is in it? The doctor says: what’s the harm in attending an industry-funded symposium in Boca Raton as long as I look at the presentations with a skeptical eye? The department head says: what’s wrong with taking money from Janssen or Merck to fund our Grand Rounds program if it means we can bring in more high-profile speakers? The journal editor says: what’s wrong with publishing an industry-funded editorial or review article as long as it gets appropriate peer review? The ethicist says: what’s wrong with funding our centers with industry money as long as the gifts are unrestricted and the funders are not issuing any orders? But it is only when all these cogs click together that the machinery is put into motion (Brody 455).
The physician-industry relationship is growing tighter every day. A study published by the New England Journal of Medicine showed that 94% of physicians reported having some kind of relationship with the drug companies. Most of the time, this manifested in free food and drug samples. However, some doctors also reported having financial ties to the industry. In fact, 35% of the respondents were reimbursed by the drug companies for CME or other types of professional meetings. Even worse, 28% reported to have been paid by the companies to consult, give medical lectures, or enroll patients in trials (Campbell). The influence drug companies have on the prescribing practices of our doctors is quite evident. “A broad investigation of over 500 previously published studies found that physician interactions with drug representatives were frequent and were associated with requests for additions to the hospital formulary and changes in physicians’ prescribing practices” (Sade 399). Even though it is nearly impossible to design a study to prove that a single factor can lead a doctor to write a particular prescription, studies published in the 1980s linked the content of CME meetings to commercial sponsorship influence. The studies showed “that later prescribing by attendees was likely to favor the products of the CME commercial sponsor” (Brody 455). Unfortunately, industry influence and manipulation can be traced all the way back to research and development. There is a lot of evidence that suggests that pharmaceutical companies design clinical trials to make sure their drugs come out on top, often spinning trial results and withholding negative outcomes. Industry influence is especially evident in that a trial sponsored by a drug company is 3.6 times more likely to reach an outcome that promotes the sale of the drug than in a neutral trial (Bekelman). There are a number of ways in which a drug company can manipulate clinical trials. In one form of manipulation, the people the companies select for clinical trials are often unrepresentative of the kinds of people the drug will be prescribed to. For example, “Nearly two-thirds of all cancer patients are 65 or older, but only one-quarter of the people in cancer studies have reached 65” (Abramson 104). Before 1980, researchers frowned upon industry support and most of the clinical studies were publicly funded. However, medical studies are quickly becoming overtaken by the industry. Today, three quarters of the studies published in the top three medical journals are funded by the pharmaceutical industry (Abramson 121). The pharmaceutical industry is becoming a dominating force of influence in our modern healthcare system. The manipulation they employ in their fight to expand their bottom line is reshaping the entire structure of the medical establishment in ways that must be addressed. After all, “The drug companies have no more responsibility to oversee the public 's health than the fast-food industry has to oversee the public 's diet” (Abramson 243). We cannot continue to let a system thrive that focuses more on pill pushing than healing.
Annotated Works Cited
Abramson, John. Overdosed America: The Broken Promise of American Medicine. NY: HarperCollins, 2004. Print. This book provides many examples that show how the pharmaceutical industry has misled doctors and the general public in an attempt to sell more drugs.
Barlett, Donald L., and B. Steele. James. Critical Condition: How Health Care in America Became Big Business. New York: Random House Large Print, 2004. Print. This book includes the statistics used to show the vast amount of money the industry spends on lobbying.
Bekelman JE, Li Y, Gross CP. “Scope and Impact of Financial Conflicts of Interest in Biomedical Research: A Systematic Review”. JAMA (2003): 454–465. Journal of the American Medical Association. American Medical Association, 22 Jan. 2003. Web. This article shows that a research trial sponsored by the industry is more than 3.6 times more likely than a neutral trial to reach conclusions favorable to sales of the drug.
Brody, Howard. "Pharmaceutical Industry Financial Support for Medical Education: Benefit, or Undue Influence?" Journal of Law, Medicine & Ethics (2009): 451-60. Print. This article outlines our modern system of continuing medical education and provides evidence highlighting the core problems with drug industry funded CME programs.
Campbell, E. G., R. L. Gruen, J. Mountford, L. G. Miller, P. D. Cleary, and D. Blumenthal. "A National Survey of Physician-Industry Relationships." New England Journal of Medicine 356.17 (2007): 1742-750. New England Journal of Medicine. Massachusetts Medical Society, 26 Apr. 2007. Web. 5 Nov. 2012. This survey provides the evidence used to outline the financial relationship between the industry and the physician.
Sade, Robert M. "Dangerous Liaisons? Industry Relations with Health Professionals." The Journal of Law, Medicine & Ethics 37.3 (2009): 398-400. Print. This article is used to show the ill effects of industry influence on patient care. It gives evidence exposing industry control in trial design, data analysis, and publication.
"The AMA 's Lobbyists & Political Contributions." Political Correction. Media Matters Action Network, 11 June 2009. Web. 5 Nov. 2012. This website outlines political campaign donations and shows how the American Medical Association use the same lobbyists as the big pharmaceutical companies.