Spurious Reasoning about Pharmaceutical Ethics

A recent New York Times Op Ed by Peter Pitts, President of the controversial Center for Medicine in the Public Interest, attacks the idea of federal funding for studies that compare drug effectiveness in terms that will soon show up in drug company lobbying.

In a breathtaking piece of spurious reasoning, Pitts argues that because Medicare would probably not pay for costlier medications if cheaper ones were equally effective – an enlightened and fondly-to-be-hoped-for policy – it is a conflict of interest for the National Institutes of Health and other government agencies to fund comparative effectiveness studies.

It is entirely reasonable to criticize specific comparative effectiveness studies on methodological grounds. That is what science is all about. But Pitts dismisses the very concept of comparative effectiveness studies as “flawed.”

Pitts speaks of “cost concerns” as if caring about cost is the devil’s work. He is dead wrong. To make health care more widely available, to fund other social priorities, and to allow U.S. industries to be more competitive, we need clinically informed, ethically guided health care cost containment. Ethical physicians should join together to set limits on which drugs will be paid for by insurance funds, and to ensure that a robust process for appeals and policy revision is in place.

Pitts argues against cost containment by invoking the bogeyman of Medicare “forc[ing] doctors to prescribe only the drugs that Medicare will pay for — not the ones that are best for the patient.” The implied premise is that whatever any individual physician prescribes is, by definition, what is best for the patient. No informed person really believes this. There is huge variation in prescribing practices. Evidence is one source of prescribing behavior. Patient demand, often fueled by direct to consumer advertising, is another. Drug company sponsored dinners, speakers, seminars, and holidays, is still another.

We can’t leave the key to spending insurance funds in the hands of every individual physician without oversight. That oversight should come from expert medical guidance. Fair process in setting needed limits is what a Center that is truly “for Medicine in the Public Interest” should be lobbying for, not anything goes prescribing.

The fact that the Center for Medicine in the Public Interest is partly funded by drug companies does not invalidate Pitts’s arguments. But the combination of spurious arguments that favor unbridled prescribing and drug industry funding does not pass the sniff test.