The Truth about the Critical Condition of Overdosed America

Article excerpt

Recent news about the flu-vaccine shortage, removal of Vioxx from the market and revelations that Paxil and similar antidepressants double the previous incidence of suicidal ideation by teenagers is raising serious questions about the system of prescription-drug development, manufacture and regulation in the United States. These and other revelations are turning up in headlines at a time when the U.S. healthcare system is increasingly under the microscope.

The debate has intensified with the publication of at least six books so far in 2004 by major publishers, all with provocative titles including The Truth About the Drug Companies: How They Deceive Us and What to Do About It by Marcia Angell (one of two former editors of the New England Journal of Medicine (NEJM) to write such a book); Critical Condition: How Health Care in America Became Big Business-and Bad Medicine by Pulitzer Prize winners Donald L. Barlett and James B. Steele; and Overdosed America: The Broken Promise of American Medicine by John Abramson of Harvard Medical School.

INITIATIVES FOR CHANGE

In addition to this surfeit of texts, the editors of the 11 largest and most influential medical journals announced this fall that they will no longer review a clinical trial for publication unless it has been registered on a new central database. This extraordinary measure comes in the wake of evidence that drug companies were suppressing research showing that some of their drugs are not effective or produce harmful-even fatal-side effects. A growing chorus of experts is clamoring for the government to require pharmaceutical manufactures to enter all studies, positive or negative, on such a database.

Furthermore, Consumers Union, publishers of Consumer Reports magazine, is announcing a twin initiative on prescription drugs in November. One aims to educate the public about where best to obtain the best-quality, most effective prescription drugs at the lowest price. A separate initiative is intended to advocate for improvements in related public policy.

Last year, University of Minnesota geriatric researcher Robert Kane, after finding himself frustrated in his efforts to assist his own mother, formed the group Professionals With Personal Experience in Chronic Care. The group's website (www.ppecc.org) states, "Our message to policymakers and health system leaders-If professionals working within the healthcare system are having serious problems with getting care for themselves and their families, then the system is failing in a major way."

Although prescriptions for change differ widely, nobody believes there isn't a significant problem. Even a conservative think tank, the Pacific Research Institute in San Francisco, published a book this fall titled Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer by the institute's director, Sally C. Pipes. Whether the ultimate remedy lies, as Pipes believes, in free-market remedies, in a Canadian-style single-payer system or in another shade of reform, no changes in the perverse economic incentives now driving the U.S. healthcare and prescription drug system can be enacted without a buy-in from stakeholders ranging from consumer advocates to major players in the business of healthcare.

In the realm of prescription drugs, the potential contribution of the pharmaceutical manufacturers to the future health of older Americans-for treating such debilitating conditions as Alzheimer's, diabetes, incontinence and rheumatoid arthritis-is outlined on the website of the Pharmaceutical Association of America (PhRMA) at www.phrma.org. In 2003, reports the PhRMA site, "member companies invested an estimated $33.2 billion on research to develop new treatments for diseases-an estimated 17.7% of domestic sales on research and development-a higher R&D-to-sales ratio than any other U.S. industry." Still, the percentage devoted to marketing and administration was almost double this amount, a point of concern raised by Angell and other authors. …