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Friday, May 13, 2005

Retired Doc's opinion on "Big Pharma" at all time low and falling

The first medical memory I have of what- at the time- were known as "ethical drug companies" was actually part of the rites of passage from medical student to doctor. It was the doctor black bag that Lilly gave to graduating medical students .
For years,I considered the detail men who brought samples and doughnuts to the office as basically benign and took their brief promotional comments re their drugs superiority over competitors with healthy skepticism.
But now, once I read alleged details of Merck's action re the VIGOR study and its marketing of Vioxx, I cannot think of Merck and- by extrapolation and belief there may be no difference among large pharma entities-other large drug companies with any thing but suspicion and distrust.
The gist of the "Kaiser Health Report" linked above describes marketing techniques that seem, at best, misleading in turn leading physicians to prescribe Vioxx, which a number of doctors now wish they had never done. If this was merely one company misleading physicians and the public about side effects of a drug, that would be bad enough.But there appears to be more.
There is reason to believe that in some instances drug companies have manipulated study results so that when they are published ( in main line journals) the results do not represent all of the data in such a way that opposite conclusions may have been reached if more of the data set were presented to the journal. Case in point: The 2000 JAMA article regarding celecoxib (Pfizer's Celebrex) which published 6 month data showing a better side effect profile re: GI concerns than older NSAIDs while they withheld the 12 month data which painted a different picture.
You have to worry that this is a ice berg tip and how many of the drug industry- financed and designed RCTs if carefully analyzed ( with data even journal editors do not have access to) may not really demonstrate what the articles concluded. And it is the RCTs which are the gold standard of information feed into various consensus and guidelines writing committees.
A number of professional organizations have warned physicians about undue influence regarding free meals and trips etc. If the manipulative antics of two of the drug industry giants are any thing but two isolated aberrations, the influence we need to be concerned about is much more serious than a free dinner at a toney establishment. We need to worry about how much of the "evidence" in "evidence based medicine" is suspect and how many well intentioned, honest hardworking academic physicians may have been conned as well. A recent Health Care Renewal posting links to a detail filled Wall Street Journal article dealing in part with discrepancies between the data obtained and the data reported in a number of articles at least some of which were drug company designed and managed. There is also the issue of "ghost writing, which has been well blogged about, in which drug companies hire "medical information" companies to write articles promoting a given product or group of products and then enlisting academic docs to add a bit of prestige veneer to the publication.
I don't know when Lilly stopped giving out the black bags, but I don't think many med schools would favor resumption of the practice. About forty years ago when I began to carry around my black bag as an intern, the descriptor "ethical" attached to " drug company" would have seemed quite reasonable if anyone would have given it any thought, which we didn't. But now...By the way news articles still use that term.

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