The medical industry is up in arms against the pharmaceutical industry. The Associated Press, under the headline “Battling the growing influence of the pharmaceutical industry”, reported last week on the growing band of medical industry leaders hostile to drug company influence over the decisions that doctors make.
According to Catherine DeAngelis, an editor at the Journal of the American Medical Association, “The influence that the pharmaceutical companies … are having on every aspect of medicine … is so blatant … you’d have to be deaf, blind and dumb not to see it.” She then goes on to say that doctors “have just allowed them to take over, and it’s our fault, the whole medical community.”
The way I see it, the so-called medical community is not at all the victim of an evil corporate master, a victim who, through inattention, allowed horrible people in suits to take over their medical practices. The medical industry, including the editors of the leading journals, in fact were the one’s who quite intentionally created this monster.
Beginning about 50 years ago, with the increased attention on prevention of chronic disease, medical practice shifted from treating acute conditions such as infectious disease that last for a short period of time to treating chronic conditions such as heart disease that last for the rest of the patient’s life. The medical industry worked hand-in-hand with the pharmaceutical industry to find solutions. Clever people in the pharmaceutical companies quickly figured out that this was a gold mine: they could develop drugs that would be sold to a patient from the day of the first prescription to the day the patient died.
With the money that poured in from these pharmaceutical cash cows, companies did what you would expect any corporation to do: they used their mountains of money to buy influence that would keep the cash cow thriving.
As the Associated Press article notes, although the medical industry is riled up, it nevertheless has a love-hate relationship with the pharmaceutical industry. On the one hand, doctors don’t like being pushed around. On the other hand, they depend on the pharmaceutical industry’s mountain of money to do research and develop new drugs. The medical industry’s solution? Really strict rules on such things as gifts to doctors, how drugs are marketed, declarations of conflicts of interest in professional journals, and other lukewarm reforms of a kind that have never worked in any other industry. As one industry analyst observed, drug companies are very clever and will find ways to adapt: “The earlier you can hook one of these doctors, the more loyal they are.”
Here’s some basic economics for the medical industry. Right now, the road to treatments for medical conditions is controlled by drug companies using their mountain of money. The money is principally collected from insurance companies that collect it from payers of insurance premiums that consist of individual people and employers that in turn collect money from the people who buy their products or pay taxes. At each step, a slice is taken out for administration and profits. So why maintain this road to treatment with such a Byzantine and ultimately corrupting process? Why not just allocate research money from our taxes, have the research decisions made publicly, and have pharmaceutical products distributed by a public agency.
However, if you were paying attention you’d recognize that this isn’t the only problem or even the principal problem. The verdant growth of drugs and the medical culture it has spawned is firmly rooted in the fertile soil of a medical industry prone to overdiagnosis and overtreatment. The fertility of that soil comes from the predominance of treatments for disease prevention by a medical industry that is ill-suited to the task.
It is increasingly clear that the doctor’s office is the wrong place for protection and prevention. What we’ve come to understand is that our social and physical environments have a profound effect on our health, including a wide variety of medical conditions. Real protection and prevention will only come from profound political and economic change that prevents exposures to social and environmental toxins.
The doctor’s office is not the place to find those solutions. Where we’ll find them is in living rooms, social clubs, community centers, churches, grocery stores, classrooms, street corners, legislative chambers, regulator hearing rooms, and anywhere else that people can use their power to create a better life.
