Big Pharrma & Doctors

FROM http://healthcare.change.org/blog/view/does_big_pharma_speak_for_you

You can make a difference.  Go to WWW.SICKOCURE.ORG get some info, sign the petition for HR676 and contact your representatives.

Then go to WWW.WHITEHOUSE.GOV/CONTACT and contact the White House directly.

We already know that PhRMA, the trade association for drug and pharmaceutical companies, stands a lot to lose if we succeed in reforming health care to aggressively control costs, no matter how nicely they're playing in public forums now.  We also know exactly what they'll target, and what they'll say.  As revealed on a press call with Billy Tauzin, PhRMA will claim it is acting out of the interests of doctors and their patients.  My question to you is - Are they?  Does Big Pharma speak for you?

The target, as it was during the spurious debates about health care provisions in the American, is comparative effectiveness research.  The claim, as Tauzin put it today, is that "Anything that takes us to a place... where government is making decisions instead of doctors and patients is a hot spot for us."  Ergo, research is bad because it inevitably interferes with the decisions a doctor makes.

This will surprise the hell out of most doctors I know.

For one thing, most of the doctors I know actually want to know the results of such research, and for it to come to them in an easy-to-digest form.  If you put yourself in the doctor's shoes, that's only natural.  Medicine is a science, and doctors have been trained since medical school with the notion that it's an evolving science.  But they're also incredibly busy seeing patients, dealing with cases, etc. to follow up on every single treatment even within their field.  They might read The New England Journal of Medicine and other best-of-the-best anthologies, and they may read studies released by the FDA on certain drugs or, even worse, they might read the entirely-too-available studies that are funded partly or in whole by the drug companies themselves (the ones that always seem to say that the drug they want you to buy is the most effective one - surprise!), but good data on the effectiveness of the treatments are hard to come by.  No one's much interested in doing it except government research entities like the National Institute of Health.

The best example I've seen of this question comes from Dr. Ezekiel Emmanuel in his book Healthcare, Guaranteed, from his particular field of oncology.  Given his example, it's hard to see how learning more about the treatments he's prescribing would be overruling his decisions:

Consider treatments for early-stage prostate cancer.... Traditional radiation therapy costs $11,000; the [radiation] seeds runs about $15,000; intensity modulated radiation therapy (IMRT) can cost nearly $42,500; and proton beam therapy is stratospheric.  Many cancer physicians think that all of these treatments are capable of producing the same survival rates, but no one knows for sure.... No one has compared these treatments head-to-head.

Put another way - given the challenges of modern medicine, doctors actually need more information to make better decisions.

For another thing, those who are defending the right of a doctor and a patient to choose their treatment and warn that knowing what the most effective treatment is will cause government bureaucrats to interfere with that decision are actually defending a status quo where that decision is routinely interfered with, usually for far less evidence-based reasons.  Private insurance is notorious among physicians for overruling the doctor, either through cost-cutting measures determining what will and will not be reimbursed, refusing to compensate (or compensate adequately) out of network specialists even when the doctor feels that specialty care is needed, catching doctors and patients in a web of pre-approvals and review by medical underwriters, and sometimes just by administrative incompetence.  How can they be for doctors and patients if they prefer arbitrary interference of that relationship to interferences based on research - research that the doctors themselves want?

So if doctors would actually prefer to have this research available to them, who is threatened by it?  Are patients? Put another way, is Big Pharma truly defending your rights by standing against comparative effectiveness research?  Or is the simplest answer the right one, and they're just looking out for their profits?

(Photo credit:  Mike Licht on Flickr.)