Tuesday, October 20, 2009

Doctors' conflicts of interest can harm your health - Part 1 of 3

As a government employee when I'm not blogging, I think that fears about a "government takeover" of health care have been greatly exaggerated by misunderstanding and persistent rumors (e.g. federal death panels) masquerading as facts. One often-stated fear in the reform debate is that personal medical decisions will be taken out of the hands of doctors. But even those who believe that our health system could use more evidence-based medicine (myself included) generally agree that individual care decisions should be left up to doctors and patients. Have you considered, though, how doctors continue to acquire knowledge to make good decisions after they complete their medical school and residency training? I finished medical school more than 8 years ago, and the aphorism "Half of what you learn in medical school will be out of date by the time you graduate" is more or less correct.

From my experience, most doctors rely on three primary sources of new information: scientific journals (such as the one I edit, American Family Physician), medical conferences, and information from pharmaceutical company representatives (or "drug reps"). You would probably expect information from the latter to be biased, since drug reps are trained to sell drugs, not to do what's best for patients. Organizations such as No Free Lunch have established that physicians who allow drug reps access to their practices to distribute free drug samples, meals, and other promotional products (such as pens, prescription pads, etc.) often end up prescribing expensive or second-line drugs to patients instead of the drugs recommended by national guidelines. Led by the American Medical Student Association, many medical schools have now established strict rules governing interactions between students, faculty, and drug companies.

But pens and drug samples are only the most visible ways that drug companies push their products. Recently, it has become obvious that an entire hidden industry of drug-company funded "ghostwriters" has been publishing articles in medical journals for years. A study by the editors of the Journal of the American Medical Assocation found that from 2-11 percent of articles published in 2008 in six major journals (including the New England Journal of Medicine) were actually written by people who were not named as authors. While the study could not establish that these particular ghostwriters had been directly financed by drug companies, the practice of writing up a scientific study and then recruiting a lead author (usually an academic physician under pressure to "publish or perish") has been well-documented in the case of previous "blockbuster" drugs that were taken by millions of patients for common conditions but later turned out to have dangerous or fatal side effects, including Wyeth's Prempro and Merck's Vioxx.

In an upcoming post, I'll discuss recent efforts by medical journals to save their scientific credibility from the "dirty little secret" of drug company influences.

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