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Monday, December 17, 2007

Pharmaceutical Companies: How Much Influence Do They Have?

The Wall Street Journal's Health Blog has an interesting discussion concerning the recent treatment of pharmaceutical companies.  It reports,

Former FDA big shot and perennial defender of the free market Scott Gottlieb makes the case in the WSJ that drug makers are being persecuted by Washington.

Exhibit A: Eli Lilly’s guilty plea to a criminal indictment from the Bush Justice Department in 2005 over the off-label promotion of the company’s osteoporosis pill Evista to reduce the risk of breast cancer in post-menopausal women.  Lilly paid $36 million in fines and disgorged its ill-gotten gains, he notes. But, Gottlieb asks, what was the crime? Lilly’s campaign to get the word out relied on findings “from a series of landmark national studies, some eventually touted by government research,” he writes. He goes on to cite another example involving the government’s investigation of Genentech for alleged promotion of Rituxan for unapproved uses in cancer.

There was the problem that Lilly only got FDA approval of Evista’s cancer indication this September.

But in Gottlieb’s view, ” ‘Off label’ are now dirty words in (the) conventional lexicon, made synonymous with lawbreaking as a result of these prosecutions, even though these words describe the way more than half of cancer medicine is practiced. It is true that some off-label drug use is based on very unsettled science and has more risks. But medicine — and not just cancer care — involves lots of hard choices.”

On this very same day, Paul Krugman, writing in the New York Times, notes how hard it will be to reform health care partially because of the influence of --- pharmaceutical companies.  He writes,

Broadly speaking, the serious contenders for the Democratic nomination are offering similar policy proposals — the dispute over health care mandates notwithstanding. But there are large differences among the candidates in their beliefs about what it will take to turn a progressive agenda into reality.

At one extreme, Barack Obama insists that the problem with America is that our politics are so “bitter and partisan,” and insists that he can get things done by ushering in a “different kind of politics.” At the opposite extreme, John Edwards blames the power of the wealthy and corporate interests for our problems, and says, in effect, that America needs another F.D.R. — a polarizing figure, the object of much hatred from the right, who nonetheless succeeded in making big changes. . . . .

The argument began during the Democratic debate, when the moderator — Carolyn Washburn, the editor of The Des Moines Register — suggested that Mr. Edwards shouldn’t be so harsh on the wealthy and special interests, because “the same groups are often responsible for getting things done in Washington.”

Mr. Edwards replied, “Some people argue that we’re going to sit at a table with these people and they’re going to voluntarily give their power away. I think it is a complete fantasy; it will never happen.”  This was pretty clearly a swipe at Mr. Obama, who has repeatedly said that health reform should be negotiated at a “big table” that would include insurance companies and drug companies.

On Saturday Mr. Obama responded, this time criticizing Mr. Edwards by name. He declared that “We want to reduce the power of drug companies and insurance companies and so forth, but the notion that they will have no say-so at all in anything is just not realistic.”

Hmm. Do Obama supporters who celebrate his hoped-for ability to bring us together realize that “us” includes the insurance and drug lobbies?  O.K., more seriously, it’s actually Mr. Obama who’s being unrealistic here, believing that the insurance and drug industries — which are, in large part, the cause of our health care problems — will be willing to play a constructive role in health reform. The fact is that there’s no way to reduce the gross wastefulness of our health system without also reducing the profits of the industries that generate the waste.

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