Attack on Pingree campaign a bitter pill

Douglas R. Johnson’s op-ed attack on Chellie Pingree’s campaign for the U.S. Senate (BDN, June 5) is disingenuous in its representation of the socio-economic benefits of the pharmaceutical industry and, more importantly, is dangerously misleading in its misstatements of medical fact. Indeed, his prevarications, so typical of the marketing and public relations efforts of the pharmaceutical industry and its apologists, offer a powerful argument in favor of a stronger government role in monitoring and regulating the industry.

Johnson’s assertion that for each new drug developed $200 million is added to the economy annually is utter nonsense. In fact, the United States spends 40 percent of the world’s healthcare dollars on 5 percent of the world’s population and has only the 26th best health care outcomes in the world. An aberrantly high and increasing percentage of that spending is on prescription drugs. Your readers know this to be true every time they fill a prescription.

The pharmaceutical industry, by far the most profitable industry in the United States (is it any wonder that Pingree has investments in it … what financial adviser would not recommend it?), spends more in advertising and promotion each year than in research and development. Approximately $13,000 of promotional money is spent (and deducted) by the industry every year for each medical student, resident and physician in the U.S. Not to mention direct-to-consumer advertising on TV and in other media.

Alarmingly, Johnson spews the industry’s promotions of particular drugs with no mention of the real clinical facts. The clot-busting drug promoted for strokes, tissue plasminogen activator (TPA), is marketed by Genentech and, sadly, is recommended for use by the American Heart Association. It is also very expensive.

The AHA recommendation was made after Genentech paid to build the AHA headquarters in Dallas, and all of the members of the panel writing the recommendation received research funding or lecture fees from Genentech. The lone dissenter from the recommendation, Dr. Jerome Hoffman, had no relationship with Genentech and felt so strongly that the recommendation was wrong that he had his name removed from the guidelines. What was the cause for his concern?

Genentech’s own studies, the NINDS and ATLANTIS trials, each showed only marginal benefit for those patients who received TPA, and even that can’t be reproduced in non drug company sponsored trials. But most critically, and what Genentech doesn’t want the public to know, is that in their own NINDS trial, 1 out of every 11 patients died from complications caused by TPA. And in the ATLANTIS trial, 1 out of every 8 patients died from complications caused by TPA! In a Cleveland study (not sponsored by Genentech) patients receiving TPA for stroke had twice the death rate of those who were not given TPA. Is it surprising that hospitalizations were shorter in the group treated with TPA? I would suggest that Johnson read the recent British Medical Journal article by Jean Lenzer, which outlines the entire scandal in detail (BMJ 324:723-726).

Similar exaggerations are made by Johnson regarding asthma and Alzheimer’s drugs. Each of his claims can be easily refuted but the point is clear. The pharmaceutical industry has one motive and one motive only: profit. When that motive coincides with the development of good drugs that really work, it serves the public’s interests, albeit at great expense.

When it does not, the results can be disastrous.

With the medical profession largely abdicating its role as an advocate for the interests of the people we serve in order to gain financial benefit from the pharmaceutical industry, a more assertive regulatory role for the government is long overdue.

Noah Nesin, M.D. lives in Lincoln.