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Commentary

Drugs and Demagogues
Thomas P. Stossel, M.D., The Boston Globe, 4-17-07

Stossel argues that a draft FDA policy that would ban experts with financial ties to drug companies from serving on FDA advisory committees is a short sighted policy that will rob the agency of the best scientific advice.

IN 427 BC, the Athenians recaptured the town of Mytilene from the Spartans. The historian Thucydides described the intense debate that followed over the fate of Mytilene's citizens, who had collaborated with the enemy. Cleon, whom Thucydides characterized as a violent demagogue, argued for killing them all; Diodotus, who did business with the Mytilenians, recommended mercy.

In siding with Diodotus, Thucydides noted how some people invoke financial conflicts of interest to discredit worthy opponents: "If a man gives the best possible advice but under the slightest suspicion of being influenced by his own private profit, we are so embittered by the idea that we do not allow the state to receive the certain benefit of his good advice." In this case, the state did not benefit, and Cleon prevailed.

Recently the Food and Drug Administration furthered this venerable tradition, when it proposed to keep anyone with a financial interest of $50,000 or greater in a field of medical technology from taking part in an FDA advisory panel in that same field. But why?

The answer is not that financial conflicts of interest provably influence FDA panel recommendations. A study of advisory panel decisions published in The Journal of the American Medical Association found that advisers' financial relationships had no effect on their approval recommendations. Nor are experts who lack financial conflicts more "objective" than conflicted ones—as if otherwise "objective" advisers could be bought off for $51,000 but not $49,000.

Furthermore, medical experts who consult for private companies have the most research agency grant funds. They are the most knowledgeable, inventive, and productive scholars—which is why corporations want to work with them. Meanwhile, some groups selected for their independence can make terrible recommendations. After having to retract its assertion that certain baby car seats were unsafe, Consumer Reports magazine recently changed its policy of consulting only with experts without commercial ties. The second-best experts do not produce the best results.



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