Drug Companies and the Health-Care Crisis
Frederick W. Wolff
To the Editor:
The November–December issue was a breath of fresh air in a deteriorating atmosphere in medicine. Thomas Andreoli put it very well in his article: "As the marketplace continues to make inroads into the U.S. health-care system, a form of the Gresham effect—bad money driving out good—is taking hold in medical schools. . . . [A]cademic values are losing out to mercantilism."
A contrary opinion would ask what is wrong with the marketplace’s determining the education of physicians, the advancement of scientific research, and the delivery of health care. In my own field of interest—the drug industry—one can find an obvious answer to that question.
In the United States, an estimated thirty-five cents of every dollar earned by a drug company is spent on advertising and marketing. Drug-company sponsorship of hospital and medical-school teaching conferences serve as a veiled enticement to the impressionable mind. More obvious are weekly luncheons for doctors in their private offices or clinics, dinner evenings at upscale restaurants, and even paid trips to lectures and meetings at lovely conference centers in exotic destinations, including ample time and reimbursement for golf, sailing, and entertainment.
The problem worsens when complicated prescription drugs are advertised directly to the public over information highways and at entertainment events. The physician finds it difficult to deny the patient’s request for these drugs for fear that the patient will go elsewhere for health care. The overprescribing of antibiotics by doctors who want to placate demanding patients has given rise to the current problems with resistant bacteria, including increased morbidity and mortality.
Drug approval by a pliant Food and Drug Administration is fast and more cursory now in response to the pressures of industry, lobbyists, and a public that believes new is better. This has often led to the premature release of a drug that must be withdrawn within two years because of severe or even mortal side effects.
Sadly missing is an unbiased approach to educating the prescribing physician on a rational approach to therapeutics so that the misuse and overuse of drugs would be less likely. Many of our senior citizens are taking dozens of drugs chronically. Costs paid by individuals and insurance companies will only continue to rise if current practices persist.
How can we break the dam of indifference, greed, and intellectual stupor that pervades American medicine today?
Perhaps Congress could be persuaded to balance its fiscal and lobbying pressures, so that there would be no further deterioration of the standards of medicine for their families and the citizens they represent. What should Congress do?
- Demand that the National Institutes of Health (NIH), which receives taxpayers’ money, be completely independent in its allocation of research funds and weigh carefully investigations that might have been funded or swayed by drug firms’ marketing.
- Insist that the NIH and the Veterans’ Administration Medical System be immunized against pharmaceutical persuaders and instead form an alliance that will protect the patient while allowing the drug industry to benefit from good business practices.
- Insist that the results of scientific research funded by taxpayers remain the property of the people and not be exploited by private, vested interests. (The further development of such research successes could, however, be opened to the private sector.)
- Prevent institutions and hospitals built with government funds from sliding silently into the pockets of entrepreneurs not dedicated to health care.
- Support efforts by medical and dental schools to educate students in the rational prescribing of drugs.
If we don’t start now, the bankrupting of our health-care system will continue to proceed at a rapid rate and will be harder to fix. We must look deeper and develop a strategy that addresses the hard-core issues.
Frederick W. Wolff, M.D.
Potomac, Maryland
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