Messing with what I know

I don’t need any help being dumber than I already am, so when someone messes with what I think I know and makes me wonder if I really know it, that ticks me off more than a dog getting flipped the bird by a cat out of reach. Well, the pharmaceutical companies are doing just that – messing with what I think I know in order to get me to prescribe more of their pills to my patients. It ticks me off so much I almost need to take one of their pills to relax.

The drug companies are doing this by spending lots of money influencing the opinions of doctors who are the experts other doctors listen to about how to take care of patients. Then when those experts tell me what they think I should do I don’t know whether to believe them. This may seem like a small issue, but it is getting so bad I sometimes feel like Dr. Alice in the Mad Hatter’s pharmaceutical Wonderland.

Here’s an example. Since 2005 the American Society of Hypertension (ASH) has been telling doctors we should expand our definition of high blood pressure and consider treating patients with “borderline” high blood pressure. Doctors listen to groups such as the ASH because these are experts who interpret the blizzard of data out there about common clinical problems, and we rely on them to make their recommendations based on close study of scientific data.

When experts such as ASH make recommendations, the rest of us think we then know what we need to know about treating high blood pressure.

Turns out, maybe not. Of the seven doctors within ASH who developed its more aggressive blood pressure treatment recommendations, six have served as consultants or paid speakers for drug companies that sell blood pressure medicines. Then, three drug companies that make high blood pressure medicines gave ASH $700,000 to pay for its promotion around the country of its new standards for blood pressure treatment.

Why the heck would those drug companies care what ASH’s recommendations are to me about treating high blood pressure? If the new ASH recommendations were adopted, doctors would prescribe blood pressure medications to millions more Americans than the 65 million we already treat for traditionally defined high blood pressure. And voila, $17 billion in annual drug company sales of high blood pressure drugs goes billions higher, compared to which spending $700,000 to haul ASH around the country is pocket change.

The ASH example is just one of many instances in which the polluting effect of drug company money makes me wonder about what I am being told by expert physicians. I cannot swing a Foley catheter these days without hitting drug company influence on what physicians are being told. A 2002 study published in the Journal of the American Medical Association found that 59 percent of the authors of expert guidelines on patient care “had financial relationships with companies whose drugs were affected by those guidelines.”

Drug companies are also big sponsors of educational conferences for doctors and other health care practitioners, and that money is spent in part to buy influence on the content of that education. By one estimate, of the $1 billion spent on continuing medical education of physicians in 2003, $900 million was supplied by drug companies.

At such conferences, the drug companies routinely sponsor physician lecturers whose lecture content subtly supports the company’s drugs. That does not mean the expert’s opinion is bought and paid for, and not based on sound science, but how am I to know whether some other expert would have a different view but was not sponsored to speak by the drug company because that expert is not as flattering about its drug? I’m not to know, and that is the point; these tactics, and the influencing of expert panels, is all about making the experts believable to me so I listen to their advice to prescribe more pills.

What’s to be done? A lot, and if doctors don’t do it our political leaders should consider doing some of it for them. First, the experts we listen to cannot be listening to the drug companies. Medical societies putting on educational conferences should bar drug company sponsorship of particular lectures and lecturers. Ideally, the medical conferences doctors attend to keep themselves up to date need to be freed of drug company money. This will cause hardship; the drug company money is a cornerstone of these conferences, and other sources of funding will be required.

Second, physician lecturers and expert panel members talking to other doctors should be required to list every penny they make from drug companies, directly and indirectly. Ideally, membership in an expert panel by physicians with financial ties to the drug com-anies would be prohibited.

Third, studies of new medications, or of new uses for established medications, should be paid for by the federal government through funding by a tax on the drug industry, not directly by the drug companies themselves. Drug company sponsorship of drug trials can affect the outcome of the trials.

Fourth, and always, individual physicians need to kick their personal addiction to drug company freebies, such as gifts of meals, free pens, event tickets, etc. We can hardly demand cleanliness from the physicians who educate us and develop our practice guidelines if the rest of us are a little dirty ourselves.

(More importantly, if asked by a patient we are about to prescribe a medication for whether we accept anything free from the drug companies whose pills we prescribe, we should be able to say, “Not one darn thing.”)

Finally, and unfortunately, we all need to be a little skeptical when our health care providers tell us we need to be on a new pill, and be more aggressive about getting healthy without pills when possible. The only pill free of any drug company influence on whether I prescribe it to you is the one you don’t have to take.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.