Friday, April 3, 2009

The Backlash Against Pharma and The Role of Disease Management

Readers may recall that several physician-leaders have recently authored an article in JAMA recommending that all professional medical associations gradually reduce pharmaceutical and device support funding - except meeting hall exhibits and journal advertising – to zero.

From time to time in the near and distant past, The Disease Management Care Blog has done business with the pharmaceutical industry. It has found the exchange to be honorable for both parties. On the other hand, while serving on Pharmacy and Therapeutics Committees and while in clinical practice, it has witnessed some troubling marketing activities. The DMCB has no easy answers on what the relationship between medicine and pharma should be, but thinks the proposed funding ban described in JAMA won’t be the final word on the matter. It thinks there’s a backlash underway. Once passions cool, a new equilibrium should emerge.

In the meantime, the DMCB was unsurprised that the proposal described above exempts the medical journals. That’s because physicians ‘can easily distinguish these marketing activities from education presentations and are free to ignore them.’ In other words, leafing through the drug ads to get to the JAMA opinion piece should have little impact on the reader.

The DMCB appreciates the irony and sympathizes with the journals’ wish to reduce their readers’ subscription costs with advertising income. On the other hand, it doubts the sponsors of these ads agree that they have little impact on the very readers that the physician-leaders are working so hard to protect from the pharmaceutical and device industry. While it could be argued that the ad content is regulated, the agency charged with that oversight has a spotty tract record. What’s more, there is evidence that journal ads that pass regulatory muster still fall short.

So the DMCB has a suggestion of its own. Since journal editors know how to edit, perhaps they should apply their skill set to developing a higher standard of truth in print advertising that they accept – such as the prominent display of vetted ‘number needed to treat’ data. Alternatively, they could also consider getting in line and falling on the sword as the professional medical organizations.

The DMCB doubts either will happen. In the meantime, the disease management organizations and Pharmacy Benefit Managers have a continuing role to play in objective, ethical and conflict-free coaching of patients and providers about the risks, benefits and alternatives to the use of medications and devices. Given all the atmospherics, however, perhaps it’s time for the industry to think about developing its own set of standards that are reasonable and free of backlash politics. Given its pedigree, the DMCB thinks it could develop a more balanced approach that could help the rest of health care out of this morass.

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