Health care costs have been spiraling out of control for years in this country, but the reasons for that rise are more complex than you might think. Health care costs are inflated in part because of the distortion in medicine created when medical companies pay cash to doctors in the hopes they will prescribe pricy, less-effective drugs, devices, tests and treatments.
Drug and medical device companies do not overtly pay a doctor to use their product. That would be a bribe. Instead, they pay doctors to deliver talks, sit on boards, take part in studies, provide "consulting," and place their name on journal articles written by the company. Some of these articles so closely resemble advertising that the former editor of the medical journal Lancet famously declared in 2004 that, "medical journals have devolved into information laundering operations for the pharmaceutical industry."
When a doctor receives pay from a manufacturer in addition to the pay he receives from his employer, that’s what’s known as a conflict of interest. In other words, the doctor’s primary interest – the well-being of the patient – has the potential to come in conflict with his secondary interest – the doctor’s gratitude toward a company that just paid him, say, $5,000 to give a 45 minute talk he did not even write.
Defenders of the practice say concerns over conflicts of interest are much ado about nothing. Innovation requires business and science to work together, they say, and doctors are not so easily bought off. At the very least, all parties agree that authors of scientific articles should disclose to their readers when they have been paid by the maker of a drug or medical device they are writing about.
For its part, Mayo has attempted to wipe its system clean of such conflicts. In 2007, then-CEO Dennis Cortese, MD, wrote in Mayo Clinic Proceedings that "the best interests of our patients are served by complete disclosure of individual and institutional conflicts of interest."
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To its credit, Mayo walks its talk. It does not allow its employees to give paid speeches, take free samples, sit on the boards of companies, or sign their name to ghostwritten journal articles.
But there appears to be dissension in the ranks because recently that very same Mayo journal offered prominent placement of a former drug industry employee’s opposition to disclosure of conflicts of interest. In September, the Proceedings published a controversial article by a physician named Laurence Hirsch, in which he dismissed the concern over conflicts of interest as "a politically correct herd mentality."
Hirsch, the journal disclosed, is a former executive at Merck, and he worked there during the period of promotion for the inadvertently deadly, since-withdrawn drug Vioxx. That matters, because Hirsch went on to argue in his article that critics of conflicts of interest often have conflicts of their own (like taking money from law firms), and that journals should publicize those conflicts. This all seemed fair enough, but then to illustrate his point, Hirsch singled out two researchers who took money from lawyers in the process of bringing the public’s attention to the dangers of…wait for it…Vioxx.
Some might call that drug-industry payback, and in a Mayo journal supposedly dedicated to science, but you can draw your own conclusions. Only paragraphs later, however, Hirsch reversed course and advocated the return to the days of no disclosure at all. "Readers should ask themselves if they are ‘helped’ by page-long columns of disclosures for authors today," Hirsch wrote, "in contrast [to] the tangible benefits of academic-industry collaborations over the past several decades."
In an accompanying editorial, Mayo physician William Lanier cited the Mayo inventors of cortisone as examples of what we stand to lose if we continue to push for greater transparency in the medical system — or at least if we do not publicize the pay given to its critics, as though the tide has turned and the deck has now become stacked against the drug industry. "The downstream effect of such actions," Lanier wrote, "could be to stifle creativity and productivity in the United States and move industry research and development abroad."
Those are strong words. But consider this. For every dollar spent discovering a new drug or medical device in our financially incestuous medical system today, it's believed that private industry often spends another dollar trying to sell it. It did not used to be this way, of course, and it did not need to. No one needed to be sold on the need for cortisone.
Merck is apparently pleased with its treatment in the Mayo Clinic Proceedings. According to The Chronicle of Higher Education, the company is distributing copies of the article. Who needs advertising, right?
