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John Hopkins
John Hopkins
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The Drug Business, Broadway, and Casper the Friendly Ghost

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Ghost writing”: a person who writes books, articles, etc. for another who professes to be the author. Drug companies spend billions of dollars advertising drugs that neither I nor you can go to the store and buy.

Drug companies produce million dollar ad campaigns filled with beautiful fields of flowers; balloons flying around beautiful actors; and very sophisticated, successful, or just plain fun people who take the drug du jour, much to the better fulfillment of their lives. Then these same drug companies spend millions to market these drugs to physicians; ultimately the only class of people who can really open the gate to consuming of drug company products. Quite a long way around the block and a huge investment to sell a product.

On the direct marketing side, virtual Broadway productions are put together to convince consumers to ask their physician to prescribe this drug or that drug to cure the ills they have; or the ills they have finally realized they have after seeing the well heeled drug company ad. We are entertained and we are informed of all the symptoms we did not know we had; the diseases we might have; and the drugs available to treat one or the other.

Drug companies have traditionally justified the effectiveness of their drugs through “independent” research, usually funded by the drug company manufacturing the drug being researched. Once the research was conducted and the conclusions reached, the findings were published in responsible, self-regulating medical journals. These various articles served to demonstrate to the medical community, largely physicians, that the particular drug was a good one for patients.

We now find that at least some drug companies have been ghost writing supposed “independent” research articles for physicians, researchers, and experts. I am guessing that the way it works is Big Drug Company marketing person calls well established, expert physician and says something like:

“Gee, doc, we have this research we have done that leads us to the well founded conclusion that our new drug can cure the common cold. We need someone like you (an expert with a well heeled reputation) to sign off on the legitimacy of the research in an article we intend to submit to one of the well respected, self-regulated journals. What? Oh, of course its all true. We did this research entirely independently and our, er your conclusions are well supported. Yes, we stand to make a kazillion dollars on this one. Well, we can’t pay you a kazillion in fees, but maybe something in the high multiple figure range."

We then see a big production commercial about drugs and our learned physicians, for good reason, are forced to rely on Big Pharma’s Fairy Tales for evaluation of whether to prescribe a given drug.

Some publications like the Journal of the American Medical Association are questioning the real extent of ghostwriting, but frankly in my book, any is too much. The New England Journal of Medicine opines that maybe around 10% of articles involve some amount of ghostwriting.

Senator Charles Grassley has been spearheading Senate bill 309, Physician Payments Sunshine Act of 2009:

Physician Payments Sunshine Act of 2009 – Amends part A (General Provisions) of title XI of the Social Security Act to provide for transparency in the relationship between physicians and applicable manufacturers with respect to payments and other transfers of value and physician ownership or investment interests in manufacturers. Requires any manufacturer of a covered drug, device, biological, or medical supply that makes a payment or another transfer of value to a physician, a physician medical practice, or a physician group practice to report annually, in electronic form, specified information on such transactions to the Secretary of Health and Human Services. Requires any such manufacturer, or related group purchasing organization, also to report annually to the Secretary, in electronic form, certain information regarding any ownership or investment interest (other than in a publicly traded security and mutual fund) held by a physician (or an immediate family member) in the manufacturer or group purchasing organization during the preceding year. Prescribes administrative penalties for failure to comply with these requirements. Requires report submission procedures to ensure public availability of required information on a website.

So what can the consumer do? When you see your physician, be open and candid about your actual symptoms and your entire medical history. Your physician is trying to help you.

Ask questions about any tests your physician wants to do; what your physician expects the tests may show; and what your physician thinks you could be suffering from. Ask your physician where you might go to read about the tests and his or her differential diagnosis.

If your physician suggests prescribing drug treatment, ask questions:

What condition is he or she trying to treat?

What is the drug intended to treat?

What are the potential complications of taking the drug?

What adverse reactions from the drug are possible and what reactions are more likely than some of the others.

Is there a period of time before you will begin to experience the effects of the drug?

How long will you need to take the drug?

Are there alternative drugs to the one being prescribed? If so, why is your physician prescribing this particular drug?

Are there alternatives to taking any drug for the particular medical condition? If so, why is the physician recommending drug therapy?

Ask anything else you want an answer to and insist on clear, understandable answers. It’s your body and your healthcare decisions to make with the guidance of a trusted physician.