Marcia Angell, author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It (2004), has just published her latest polemic in the January 12 issue of the New York Review of Books. The influence of pharmaceutical manufacturers has become so profound and pervasive, she writes, that “it is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.” This is a conclusion she reached “slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”
While Angell is hard on drug companies for over-promoting their products, and inventing new disorders to stimulate demand for their treatments, she is even harder on the medical profession. In a capitalist economy, after all, companies are responsible for increasing shareholder value. But “physicians, medical schools, and professional organizations have no such excuse, since their only fiduciary responsibility is to patients.” To her way of thinking, doctors and academic medical centers should never take money from industry, beyond the direct cost of research projects. Nuance and ambiguity do not figure into her view of the world. Money corrupts; there are no benign conflicts of interest.
She maintains that the present controversies surrounding relationships among industry, physicians and medical schools – stirred by Sen. Charles Grassley and others in Congress – are creating a crisis of confidence in the integrity of American medicine. Unless the medical profession endeavors to “put and end to this corruption . . . the government will step in and impose regulation.” Still, most of us would agree with her conclusion: “No one in medicine wants that.”
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