August 16, 2007

The august NEJM today published an editorial by one Jerry Avorn, M.D., and all you need to know about it is the opening sentence: "In many sectors of American life... the government stands poised between powerful industry groups and the needs of the citizenry."

Thus began "Keeping Science on Top in Drug Evaluation." Yes, Dr. Avorn actually believes that government bureaucracies have both the information and the incentives needed to protect helpless consumers. Is there any hint at all in this missive that the FDA might have political incentives to keep drugs off the market too long? Well, no.

More to the point, the "science on top" mentality is fundamentally wrong, because "science" cannot tell us the correct tradeoff between safety, effectiveness, adverse effects for given patients, etc. That sort of evaluation is impossible for a top-down regulatory system; only individuals can know what tradeoffs they are willing to accept. But that is no matter for the likes of Dr. Avorn: Citizens are children and Science and Big Government are Mommy and Daddy. Or is it Daddy and Mommy? I doubt that Avorn realizes that Big Government is always the Daddy in a family in which abuse is the norm rather than the exception. Precisely what is it about medical training that yields expertise in policy analysis?

The end of the article notes that Avorn has been a pro bono expert witness for plaintiffs in Vioxx lawsuits. That speaks so very loudly.

Posted by Benjamin Zycher at August 16, 2007 06:27 PM

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