Big Pharma's Enclosure of Academic Medicine

[marmar]

from OnTheCommons.org:



Big Pharma's Enclosure of Academic Medicine
Marcia Angell documents how drug companies have corrupted the integrity of drug research, medical education and clinical practice.

By David Bollier


Anyone who works in clinical medical practice is keenly aware of Big Pharma’s relentless and intrusive marketing practices. You can’t avoid it. The pens, notepads and schwag plastered with the brand-name anti-depressants. The ubiquitous “detail” salespeople who schmooze up doctors and shower them with free samples. The physician junkets to exotic resorts to hear “educational” lectures by esteemed leaders of the field.

I know all this. What I didn’t realize was how thoroughly drug marketers have corrupted academic medicine — the research at medical centers, the education of new doctors at medical schools, and daily clinical practice. In the May-June issue of the Boston Review, Marcia Angell, the former Editor of the New England Journal of Medicine, documents in devastating detail how the drug industry has insinuated itself into every imaginable nook and cranny of academic medicine in order to sell its drugs.

The best indication of its success is the invisibility of the marketing. The sales propaganda has gotten so effective that it is brilliantly disguised as high-minded “education.” Marketing has become a normative part of medical education, research and practice.

In her sober, understated indictment, Angell, Senior Lecturer in Social Medicine at Harvard Medical School and author of The Truth About the Drug Companies, writes:

The boundaries between academic medicine — medical schools, teaching hospitals, and their faculty — and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.

Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies — like other investor-owned businesses — are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.

This profound difference in missions is often deliberately obscured — by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.

Angell’s essay marshals a considerable amount of empirical research to make her case. And while not all of the charges are new or shocking, the steady accretion of facts makes a powerful case that academic medicine has willingly surrendered its integrity and independence to the drug industry — with troubling consequences for the safety and scientific merit of many drugs and types of medical treatment. ............(more)

The complete piece is at: http://onthecommons.org/content.php?id=2739

[Donnachaidh]

1. the boundaries he speaks of were breached DECADES ago

Read Devra Davis's *The Secret War on Cancer* to find out when Big Pharma started their take-over of the medical schools.

[cbayer]

2. Recommended. Excellent article. There are some groups pushing back. On is here:

http://www.nofreelunch.org/aboutus.htm

Thanks for posting.

:hi:

[HereSince1628]

3. Clinics will do anything if the staff are fed sandwiches and doughnuts

The reason for this is that like business everywhere medicine isn't done with cold detached calculation of an actuarial but rather with a whole lot of staff input. When questioned the folks in the office more or less say "There are lots of suppliers who sell most of the same things and we just like one guy more than the other guy."

How do I know this? I supervised three semesters of interdisciplinary honors projects that surveyed this phenomenon. The premeds on the project were surprised at their own results; the business-psych kids not really so much.

[wolfgangmo]

4. I guess it is lucky for my clinic that I make that final decision and ...

I am an asshole. I really do sit back and make detached decisions regarding who brings good clinical information. It doesn't hurt that our medical director used to be an NIH investigator and knows her research protocols. I pitty the occasional fool who does a presentation and doesn't have their ducks in a row. The last rep who was only interested in "sales" who walked into one of our inservices left in tears and never, ever contacted us again. It was pretty funny watching our medical director, a 5'5" soft spoken woman rip the shit out of this ex-football player line backer looking dude. He honestly thought he could waltz in and just shuck and jive and walk out unscathed (I say this because I personally warm every rep who does a presentation for us).

It also helps that we don't practice pharamological medicine as our basis - we focus on functional medicine / testing etc.


BTW - the OP is spot on. Pharma (and I would add insurance) has ruined most medical practices in the US. Most docs have either decided to just go with the flow and do what the insurance and pharma clerks decide would be good for you, or they struggle. Or they do what we have done and simply refuse to bill insurance or let pharma snow us. It's a hard road some days tho'. No more free seminars in the Bahama's for us.