Lifesaving SalesmenA provider of outstanding patient care, the world-renowned University of Pittsburgh Medical Center (UPMC) has long been at the forefront of medical innovation, introducing liver transplants in the 1960s and, in the following decade, debunking the idea that mastectomy should be the default treatment for breast cancer. In many cases, UPMC physicians have fought deeply entrenched medical wisdom, applying the most rigorous, evidence-based science to achieve breakthroughs. However, a new policy restricting faculty interaction with private industry—based not on evidence but on anti-corporate ideology—has the potential to tarnish UPMC's distinguished record.
Despite a current fad, medical companies should keep talking to doctors.
Thomas P. Stossel, M.D.
City Journal Online
May 27, 2008
UPMC is just the latest medical center to fall to an anti-industry movement, long incubating but accelerated two years ago by an article in the Journal of the American Medical Association. The JAMA piece recommended that academic health centers (like UPMC) severely restrict salespersons' access to physicians and ban all gifts. In addition, it enjoined universities to prohibit physicians from participating in company-sponsored education activities, and it suggested accepting corporate grants for research and education only if awarded to medical center administrators, not to researchers or educators. The reason, it explained, was that corporate sponsorship and marketing of pharmaceutical products in academic health centers had challenged "physicians' scientific integrity" and "eroded medical professionalism." Bribed by meals and trinkets, such as pens and mugs, the argument went, doctors prescribed unnecessary and costly products recommended by company sales representatives. Most damagingly, the JAMA article claimed that "an overwhelming majority of interactions" between physicians and sales representatives "had negative results on patient care." But that claim was without basis. The one study that the article cited to support it, a compilation of surveys by Canadian doctor Ashley Wazana, explicitly concedes that no data about patient care exist.
Nevertheless, UPMC dean Arthur Levine was recently quoted in UPMC's publication Pitt Med as warmly endorsing the JAMA article, many of whose proposed regulations UPMC has now implemented. Levine correctly acknowledged that medical product development comes with significant risks for companies—namely, huge investments in endeavors that frequently fail. But echoing the most extreme critics of the industry, Levine also asserted that if organizations like UPMC resist companies' marketing of products only marginally better than existing ones, the firms will divert their financial resources into the development of breakthrough products that "sell themselves."
If the dire claims buttressing the UPMC policy were based on evidence, the recommendations for increased regulation of physician-industry interaction might make sense. But not only are the claims without foundation; evidence in fact abounds that medical innovation has flourished at the same time that UPMC and others allege that it has sunk into self-serving corruption. One striking example is the country's 50 percent reduction in mortality from cardiovascular disease over the past 30 years. This spectacular progress occurred because of technological advancements—statins to reduce cholesterol, ACE inhibitors and beta-blockers to lower blood pressure, stents to help open closed arteries—that private companies not only developed, but also marketed and sold in consultation with physicians and academic medical centers.
Industry critics argue that "disinterested" experts should replace company promotion, informing physicians about what treatments they should prescribe and educating medical students about new advances. But such a system would never work. The daunting complexity of human biology makes it nearly impossible to predict which new products will be superior to old ones or, for that matter, whether they will work at all. Even marginally different products, with different dosing requirements and side effects, offer expanded choices for physicians and patients. Market competition, including advertising, allows patients and physicians to sort out, on a case-by-case basis, which products are safest and most effective.
Marginally better products are important for another reason: they sustain companies financially as they pursue breakthroughs. Take Atorvastatin (sold by Pfizer as Lipitor), not the first drug to lower "bad" LDL cholesterol in the blood but more potent than earlier ones. Pfizer uses revenues from Lipitor sales to finance research on new products such as torcetrapib, which the company had hoped would be one of the first drugs to increase “good” HDL cholesterol. In the end, torcetrapib failed in clinical trials and cost Pfizer $800 million. The unpredictability of drug innovation belies the claim by Levine and others that simply diverting funds from marketing to research would automatically produce breakthroughs that "sell themselves." On the contrary: less marketing, by reducing the sales of marginally better products, would actually endanger the creation (not to mention the public awareness) of breakthroughs.
The current accusations of widespread false advertising by medical product companies and suspicions of blanket corruption among physicians are a medical fad, like purging and bleeding. Will any of medicine’s real innovators—those who have worked with companies to develop and market new technologies, as opposed to those who carp from the sidelines—stand up to defend the industry and themselves?
Thomas P. Stossel is the director of the Division of Translational Medicine at Brigham & Women's Hospital, the American Cancer Society Professor of Medicine at Harvard Medical School, and a senior fellow at the Manhattan Institute’s Center for Medical Progress.