The Lancet, Volume 359, Issue 9319, Page 1775, 18 May 2002
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doi:10.1016/S0140-6736(02)08619-1Cite or Link Using DOI
How tainted is medicine?
Original Text
Peter Davies a, Seth Jenkinson a
Sir
As family physicians we read, and resonated with, the concerns you express.1 We think you were mainly aiming your criticisms at journal editors and consultants who accept money from big pharma, thereby losing any possibility of maintaining objectivity, perspective, and impartiality.
We suspect that the malaise goes deeper still. We drafted this letter with a pen advertising pantoprazole. We drink coffee from mugs advertising doxazosin and lansoprazole. Our mouse mats advertise celecoxib.
We sense that big pharma is now rapidly setting an agenda that makes commercial sense for them, but which may or may not be justified in terms of benefit to patients. Direct-to-consumer advertising and other awareness-raising activities can bring to light cases of disease that otherwise would go undiagnosed and untreated. Doctors are being pushed in the direction of treating lower levels of the iceberg of disease.
There are, however, two questionable assumptions behind this strategy. First that every disease must be discovered, and second that treatment is best done using drugs. The current example is the controversy over what to do about asymptomatic prostatic cancer.2
Another illustration is provided by obesity and type 2 diabetes. The drugs industry develops drugs for this expanding market. Guidelines are issued supporting the use of expensive drugs to treat obesity.3, 4 No-one stops to ask just why are we starting from here? And could we start from somewhere else please? Treating obesity with drugs is about as honest and effective as treating jaundice with camouflage cream.
The difficulty for us as family physicians is that an unbalanced agenda is being set, with big pharma doing what it does very well, and with no counterbalancing forces coming from government-backed research or from within the profession itself.
The result is that the big, clinically useful, randomised, controlled trials that inform our day by day treatment of patients are all coming from drug company research. Somewhat unsurprisingly these trials all show that powerful drugs work well. How many trials of unsuccessful treatments are published or noticed?
Who in the National Health Service is developing other ways of thinking about medicine? Who is thinking about new systems of care that may involve self-care, empowerment of patients, exercise, and non-pharmaceutical techniques? Who has an overview that can allow us to see beyond the next prescription?
We feel we are becoming like the man with a hammer to whom everything looks like a nail. Each diagnosis is simply becoming a product opportunity waiting to happen. We are becoming, willingly or unwillingly, agents of big pharma, prescribing a pill for each ill.
References
1 Editorial. Just how tainted has medicine become?. Lancet 2002; 359: 1167. Full Text | PDF(34KB) | CrossRef | PubMed
2 Yamey G, Wilkes M. The PSA Storm. BMJ 2002; 324: 431. CrossRef | PubMed
3 Guidance on use of sibutramine for the treatment of obesity in adults: technology appraisal guidance no 31. London: National Institutes for Clinical Excellence, 2001.
4 Yanovski SZ, Yanovski JA. Obesity. N Engl J Med 2002; 346: 591-602. CrossRef | PubMed