GSK recently announced that it would no longer pay doctors to promote its drugs, a move that has generated a good deal of discussion. The PBS Newshour entered the fray by featuring a debate between two Harvard Medical School Professors, Drs. Jerry Avorn and Thomas Stossel. Those who know these individuals recognize that they represent opposite sides of this debate, with Avorn being a vocal critic of the pharmaceutical industry and Stossel being a defender. In the PBS discussion, Avorn supported GSK’s actions as a step in the right direction and wished that other pharmaceutical companies would follow suit. His rationale is that having doctors talk to other doctors is “probably not the best way for doctors to learn about drugs in a fair and balanced manner.” Stossel, however, takes the view that “it’s very hard for doctors to keep up with information …..and so it’s vital for doctors to have exposure to as much information as possible.”
Certainly, the pharmaceutical industry is not perfect and is now trying to improve its reputation. Indeed, GSK’s actions appear to be motivated by this. However, I do have issues with a couple of Dr. Avorn’s views. The first involves the actual presentations made by these doctors.
“And, in many cases the slides and the content and the script are actually prepared by the drug company, and the doctor presents this information as the latest information about diabetes or blood pressure or whatever. And it’s not always clear to the audience that this is material that was really scripted completely by the drug company that was paying the doctor to give the talk.”
What Avorn is basically saying is that doctors are automatons who simply take a packet of slides and a script and go off to give speeches all for the sake of money. Does he really believe that doctors are this naïve, or worse, corrupt, to forsake their Hippocratic Oath to do a pharmaceutical company’s bidding? Yes, the slides are made by the pharmaceutical company; why wouldn’t you want this to happen? A pharmaceutical company has the resources to produce high-quality materials and this saves the doctors a great deal of time. But to assume that a doctor doesn’t have input into the content of the slides as well as the talking points is wrong. In fact, oftentimes the work being discussed by these doctors comes from clinical studies that they helped to perform. Avorn’s comment impugns the integrity of these doctors and I think that’s wrong.
Later into the debate, Avorn ventures into another topic, that of the benefits of generic drugs over new medicines.
“…as far as the effect on patients, it could be a better thing if patients are hearing not just about the most expensive drugs, but also about good old-fashioned generics that may work perfectly well, but no drug company is going to go out and teach about that.”
There are two problems with this statement. First of all, given the intense pressure on the healthcare system with respect to costs, all new drugs are being scrutinized as to the true value they add over existing drugs, including generics. Any payer or hospital formulary would naturally use the least expensive alternative in treating a patient. Furthermore, if the speaker doesn’t discuss this issue, he or she will surely be asked about this by the doctors in attendance. If the speaker and the drug company haven’t done studies showing the advantages of their new medicines over existing, less costly treatments, no one in the audience is likely to prescribe the drug.
Avorn also falls back on the familiar refrain that “good old-fashioned generics” can work perfectly well. Actually, recent studies have shown that this isn’t always the case. For example earlier this year, a report in The Lancet, a British Medical Journal, indicated that the over-the-counter pain medication, ibuprofen, posed the same degree of cardiovascular risk as Vioxx, a drug that Merck pulled from the market for these same cardiovascular risks. All drugs have safety risks, be they generic or new, and patients need to work with their physicians to understand these issues. But the automatic assumption that if it’s generic, it’s safe, is incorrect.
The sales and marketing of drugs is a controversial topic. However, the debate needs to be conducted in a manner that enables progress to be made on the issue. Misguided generalizations hinder this from happening.
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