If indeed Americans are over-consuming medications to a ridiculous extent — so much so that some call it an “epidemic” of overprescription — why do doctors buy into it?
The reasons are varied and complex, some having to do with a doctor’s natural desire to cure and to save lives and to fend off future ailments; others associated with less altruistic impulses. But one reason almost certainly is the existence of and recommendations from disease-related organizations that emanate advice on how to treat and live with various ailments. Much of this advice is directed at doctors. You no doubt have visited the websites of such groups: the American Heart Association, Susan G. Komen for the Cure, the American Diabetes Association, the Alzheimer’s Association…. You name the ailment: there’s a group for it.
Many of these organizations provide valuable information and advice for patients and their families. But it’s worth noting that some do urge testing and treatment that may not be altogether necessary or even well-advised. The Komen group, for example, advocates and has persuaded most American women that every woman should undergo regular mammograms. This, despite the fact that a closer look at this practice shows no real benefit accrues (in terms of preventing death from breast cancers) but a significant amount of harm is done. The American Heart Association steadfastly advocates for widespread antihypertension treatment of people who have no symptoms, pushing its guidelines downward to the point where two-thirds of Americans are targets for prescription drugs. The Alzheimer’s Association tells us we must watch for and treat “pre-Alzheimer’s” — another entrant in the race to make patients out of people who are not yet ill and may never be ill.
One of the first lessons I learned as a beginning reporter was to follow the money trail. Always ask: “Who profits from this?” Often the answer leads you into some very interesting terrain.
That is the case here: When you take a hard look at these organizations, you find they receive a lot of funding from Big Pharma and from makers of medical devices.
Understand: I’m not saying any or all such groups are corrupt. But common sense tells you that when an organization receives funding from special interests, its objectivity and motives may be questionable. This means it is in our interest, as patients and potential consumers of the flood of prescription drugs in which we seem to be drowning, to stay aware of the money motive.
An investigative report by Pro Publica revealed that doctors who receive gifts and payments from pharmaceutical companies tend to prescribe more brand-name drugs.
Dr. Kim Allan Williams Sr., president of the American College of Cardiology, said he believes relationships between companies and doctors are circular. The more physicians learn about a new drug’s “differentiating characteristics,” he said, the more likely they are to prescribe it. And the more they prescribe it, the more likely they are to be selected as speakers and consultants for the company.
“That dovetails with improving your practice, and yes, you are getting paid to do it,” he said.
The Project on Government Oversight (POGO), a well respected investigative reporting group, found the FDA (Food and Drug Administration) itself is heavily funded and probably influenced by the pharmaceutical industry. Astonishingly, this is written into law: the agency receives about three-quarters of its funding from drug makers through required fees, which are renegotiated at intervals. In FY 2015, “The agency spent about $1.1 billion on prescription drug oversight—more specifically, those activities the agency categorizes as part of its ‘process for the review of human drug applications.’ Congress delivered 29 percent of that money—$331.6 million. Drug companies provided the rest—$796.1 million.” This represents a huge chunk of this supposedly public agency’s funding: “Over the past two decades,” POGO reports, “‘user fees’ paid by industry have climbed from 35 percent of the FDA’s spending on such oversight to 71 percent.”
The National Health Council — the so-called “voice of the patients” urging the FDA to speed approval of drugs, willy-nilly and without wasting time trying to determine whether new products are safe, effective, or even necessary — is heavily funded by Big Pharma, according to POGO: “National Health Council gets most of its funding from drug companies; its members include many drug companies, and representatives of drug companies and their main lobbying organizations serve on its board.” Some 93% of the “patient advocacy groups” the FDA is required to invite to discussion of drug approval procedures are funded by Big Pharma. More than a third of these groups “have executives, directors, or other personnel from pharmaceutical or biotech companies on their governing boards.”
In other words, what should be objective, science-based certification of new drugs’ effectiveness and safety is largely driven by Big Pharma interests.
The American Heart Association has come under fire more than once for questionable partnerships and endorsements of drugs and other products. In 2013 — a year after it had received $521 million from corporate and non-governmental donors (including contributions of around $1 million from pharmaceutical companies producing statins) — the AHA lowered its guidelines for cardiovascular disease to take in a vast number of people and recommended statins for about 44 percent of men and 22 percent of healthy women between the ages of 40 and 75. A look at the group’s self-reporting shows that for FY 2016-17, total cash received from pharmaceutical companies and device manufacturers came to $23,865,284, with another $8,539,525 in promised commitments.
In 2017 the Alzheimer’s Association reported that total corporate giving over five years came to $7,987,782.
The American Diabetes Association reports having received at least $500,000 from each of these corporate donors:
And that’s just the elite “Banting Circle” set. Colgate and CVS Pharmacies ponied up at least $400,000; donors of at least $100,000 included the Merisant Company (maker of Equal artificial sweetener), Quest Diagnostics, and Walgreens, among others.
The National Osteoporosis Foundation numbers among its 2018 Corporate Advisory Board members Eli Lilly, AMGEN, Bristol-Myers Squibb, AgNovos, Medtronic, Pfizer, Roche — and others. Take a close look at these links: I’ve made most of them to Wikipedia, where the content is not quite so self-serving as what you’ll see on the corporate sites. You’ll find some eye-popping scandals and controversies associated with some of these companies (check out Merck’s sham medical journal!). AgNovos, which is not covered in Wikipedia (why might that be?), produces products said to combat osteoporosis.
The American College of Cardiology, which on the surface appears to be a staid professional group for medical doctors, is listed by Open Secret as a PAC (political action committee). This is not quite accurate: the organization has a PAC. The ACC ‘s website does not provide a readily avaliable a list of its corporate donors. However, last year Boehringer Ingelheim and Eli Lilly and Company announced they would support an ACC drive to reduce cardiovascular risk and disease in people with type 2 diabetes. These are large, highly profitable pharmaceutical corporations with a vested interest in expanding the markets for their products.
Look hard at this stuff, and you find yourself wondering… Who’re you gonna trust? Ghostbusters?
This is the fifth of seven planned posts on The Drugging of America.
- Overprescription
- What is NNT and how can you use it to assess the risks and benefits of a given treatment?
- The problem with treating “pre-conditions”
- Hyped hypertension: Medicating 2/3 of America
- Organizations and funding
- The “de-prescribing” movement in medical practice
- Lifestyle strategies to maintain good health without drugs