Posted by medconsumers on December 1, 2004
New Book: Overdosed America-the Broken Promise of American Medicine
No, this isn’t another book about Americans popping too many pills and paying exorbitant prices for them. Its far more worrisome premise is summed up in the long subtitle: How the Pharmaceutical Companies Distort Medical Knowledge, Mislead Doctors, and Compromise Your Health. Author John Abramson, MD, is troubled by the commercial influences that pervade all aspects of American medical care. The pharmaceutical industry’s influence can be seen in everything from the sponsoring of continuing medical education to the latest treatment guidelines that make an ever-expanding number of Americans candidates for life-long drug therapy.
A Harvard Medical School faculty member, Dr. Abramson writes that he thoroughly enjoyed practicing family medicine for over 20 years. But he had become increasingly disturbed by the new brand of medical consumerism, typified by the middle-aged male patient who came in demanding an expensive, widely advertised prescription drug (Celebrex). No amount of explaining about cheaper, safer and equally effective alternatives could change his patient’s mind.
It is not only his patients who get a skewed view of new drugs, observed Dr. Abramson, his fellow physicians were influenced by the same promotional campaigns, often masquerading as education. Whereas taxpayers once funded most medical research, the pharmaceutical industry now pays the lion’s share. By now, many Americans know that the pharmaceutical industry has one of the highest profit margins of the Fortune 500 companies. How many know that the industry spends more money on marketing (from advertising to free drug samples for doctors) than on research?
Dr. Abramson left his practice to spend the next two and a half years doing what most practicing doctors have little time to do—“researching the research.” He found that drug companies have been known to: design clinical trials in such a way that ensures their products will come out on top; withhold the trials that show negative results; focus attention on the benefits while giving short shrift to the harms; and ‘spin’ equivocal results in a way that puts their drugs in a favorable light.
What’s more, the people selected for clinical trials are often unrepresentative of the majority for whom the drug will ultimately be prescribed. Cancer drugs are offered as an example. “Nearly two-thirds of all cancer patients are 65 or older,” observes Dr. Abramson, “but only one-quarter of the people in cancer studies have reached 65.” Many of the articles published in medical journals, even the most prestigious ones, he found, are little more than infomercials for the drug.
In time, Dr. Abramson began to detect the frequent use of overblown statistics guaranteed to scare people into a life-long drug regimen. Two years ago, The New England Journal of Medicine published a study about a new, inexpensive blood test that measures blood levels of inflammation in the body called C-reactive protein, or CRP, which supposedly can predict a person’s risk of heart disease. The study followed 28,000 women over eight years and found that those with the highest CRP levels were more than twice as likely to develop heart disease. The study’s authors concluded that identifying people with elevated CRP would allow “optimal targeting of statin therapy.” In other words, a way to identify future customers for cholesterol-lowering drugs.
What’s wrong with this picture? asks Dr. Abramson after the largely uncritical media picked up the CRP story and ran with it as “ground-breaking” and “extremely important.” A closer look at the statistics from this study showed that the 28,000 female participants were less than 55 years old and healthy. Their risk of heart attack, stroke, etc. was quite small. For “every 1000 women with the highest CRP levels, there was only slightly more than one (1.3) additional episode of cardiovascular disease each year than among the 1000 women with the lowest CRP levels.” In other words, the twice-as-likely-to-develop-heart-disease statistic boiled down to a doubling of odds that were tiny to begin with.
With the relentless focus on drugs, Dr. Abramson suggests that doctors and the general public tend to overlook the considerable body of research showing that regular exercise, smoking cessation, and a healthy diet trump nearly every medical intervention as the best way to keep heart disease at bay.
Americans tend to have faith in the latest high-tech medical care, but a large Medicare study challenged some common assumptions. Areas of the country with higher concentrations of specialists have both higher health care costs and worse health care outcomes.
“The public needs access to independent expert opinion that can counterbalance the enormous influence that the medical industry wields over our beliefs about the best approach to health and medical care,” writes Dr. Abramson. (Full disclosure: The Center for Medical Consumers is mentioned twice in this book as one of the rare sources of unbiased information.) A new national public body with the independence and expertise of the Institute of Medicine , he suggests, is the only way that will ever be accomplished.
Maryann Napoli December 2004