good or evil?
Recently a whistle-blower contacted the Telegram to suggest that physicians are on the take from pharmaceutical companies.
If we were to listen to dogma, we would conclude that billions of dollars are being spent on new drugs that are no better than the old ones, that money is being made for shareholders purely on the basis of marketing hoopla, and that greedy doctors will do anything for a buck.
Dealing with pharmaceutical companies necessarily is a conflict of interest situation. However, so is doing research. Furthermore, so is providing patient care. Isn't the biggest conflict of interest getting paid to make people well when it is clear that it is in the doctor's financial best interest to keep the patient sick? Shouldn't we be providing all our services for free? This position, of course is ludicrous. We make our judgements while setting aside the untenable temptation to keep our patients sick. Similarly, ethical physicians attend teaching and meetings with pharmaceutical companies but reserve our own common sense to decide on treatment we give; we are not typically that gullible or naïve to be influenced by a mere meal or being paid for our time.
Physicians are grown-ups. We are able to make our own decisions about what is right and wrong. We don't need any muppetesque Sam-the-Eagle to tell us how to conduct our affairs, or how much value we ought to charge for our time. Fees paid to physicians to provide marketing assistance are within the guidelines established by the Newfoundland and Labrador Medical Association for services to third parties. It is reasonable for a physician to be paid for his or her time either caring for a patient or for providing consultations to third parties, whether for insurance companies, pharmaceutical companies or courts.
I am paid by the government for seeing patients. Does that make me in cahoots with the government? Does it render my judgement poor? If I am paid by an insurance company for doing a third-party assessment does that put me in their back pocket? I hope not.
Pharmaceutical companies have filled a vast hole in funding left vacant by the failure or our government to provide adequate research funding. Government make the rules about what research must be done to bring a new drug to market, yet provide very little money to see that it gets done, then drag their feet in the approval process again by not providing enough people to do the job. Pharmaceutical companies are in business to provide people with what they want in this case: health. They are the same as any business in that regard, and they will only succeed if the product does what it is supposed to do.
As it turns out, these days it takes about one billion dollars and up to 10 years to bring a new drug to market. This is a substantial up front investment, and is largely due to rules made by our government and government inefficiencies. If government provided the same research dollars as pharmaceutical companies, for the purposes of making drugs more cheaply, we can rest assured that we would be paying a much greater taxation burden to make that money available.
Older drugs are cheaper for three reasons: first, they were developed at a time when lower levels of evidence were required for approval, and less investment was required to bring them to market. Second, generic companies are allowed to make them now without having had to put up the initial investment. Third, they tend not to be as efficacious or have less desirable side effects.
I’m not saying we should never use cheaper generic drugs. I think it serves our patients to have maximum options available.
Novel antipsychotics are expensive but have had a huge positive impact on the lives of patients with psychotic and mood disorders, and save the system money in the long run. Ninety-nine per cent of psychiatrists in St John's who treat psychotic patients will agree with this. The Schizophrenia Society of Newfoundland will also agree with this.
Furthermore, pharmaceutical companies provide a large unrestricted operating grant to the early psychosis program (EPP), which is underfunded by the Health Care Corporation of St. John’s. This clinic ensures that patients get holistic and total care, beyond drugs and including family support, psychotherapy, education, social work, occupational therapy and psychological help. In turn, the EPP will do research that will benefit future patients.
Finally, some pharmaceutical companies are responsible corporate citizens, providing free medications to patients who desperately need them but cannot pay.
In closing, I will reveal that I have provided consultations to several different pharmaceutical companies, I have done research for several of them, consultations for insurance companies, consultations for other physicians, and consultations for courts and lawyers. I own no shares in pharmaceuticals. My treatment decisions are based on research, efficacy and practical experience.
We are privileged to be able to live in a time when we have drugs that make such a positive benefit in people's lives.