Big Pharma P.R. Man Bashes Comparative Effectiveness

The New York Times op-ed page rarely carries columns by paid, professional advocates of a progressive stripe. Many of its regular columnists are liberal, of course, and left-of-center academics, think tankers and authors often grace its pages with their opinions. But when was the last time you saw an argument advanced in the Times by someone from the Sierra Club, Public Citzen or the labor movement? My quick check of the Times archives suggests it was 2004 in a joint op-ed by Carl Pope of the Sierra Club and Ron Gettelfinger of the UAW.

If you're a paid advocate, your opinions almost never make the editors cut. And frankly, even though I am someone who in my current incarnation is penalized by that bias, I know why it exists and respect it. The journalistic ideal posits that an opinion writer tackle a subject with an open mind, marshall the facts, and arrive at a conclusion through the prism of his or her own intellect and experience. In that charmed circle, where I lived for many years, paid advocates are simply suspect.

That's why I was rather surprised yesterday to read an op-ed attacking government-underwritten comparative effective research that was written by a professional public relations executive. His clients include some of the world's largest pharmaceutical houses, which have a direct stake in opposing such a research center. Not only that, the paper did not reveal the primary source of the writer's income, but rather allowed him to hide behind an "astroturf" (fake grass roots) non-profit called the Center for Medicine in the Public Interest, which (at least he admitted this much) takes money from the drug industry.

The author, by the way, was Peter Pitts. He is a vice president at Manning Selvage & Lee. And you can read a list of the firms' clients here.

I suspect it's been a long time since a professional p.r. man was able to slip an undisclosed op-ed into the Times. I congratulate Mr. Pitts on his coup. Edward L. Bernays would have been proud.

I suppose my job now is to refute Mr. Pitts' argument. Frankly, I thought it was better put by Scott Gottlieb of the American Enterprise Institute in the Wall Street Journal in late August, where, I should add, his relationship to the pharmaceutical industry was straightforwardly described.

So, instead of doing a line-by-line refutation of the tired argument that knowing how well various medical therapies work in comparison to each other will somehow choke off pharmaceutical innovation, I will simply reprint what I wrote to the editors of the Journal, which printed my letter.

I was surprised by the anti-capitalist undercurrent of Scott Gottlieb's attack on comparative effectiveness clinical trials ("The War on (Expensive) Drugs," Aug. 30). When I took Economics 101, it was axiomatic that efficient markets required consumers to pursue their own economic interests - like choosing less expensive drugs if they provide the same or better therapeutic benefits as more expensive options.

"Unfortunately, today's pharmaceutical marketplace operates inefficiently because it doesn't provide consumers or prescribing physicians the information needed for medically or economically rational decisionmaking. The comparative effective trials authorized in the children's health insurance bill would help eliminate this information gap. . . "

I will not be writing a similar letter to the Times. Instead, I will spend the next few weeks scanning its corrections column to see if the editors offer a proper identification for Peter Pitts.

For more on this issue, visit yesterday's post on Health Care Renewal by Dr. Roy Poses of Brown University. He has links there to some of his posts where he lays out the counter-arguments quite well.

Others who want a the mainstream discussion about why we need and how we should organize a solid U.S. version of a comparative effectiveness institute can read this article by Gail Wilensky in Health Affairs and this article by the National Institute of Health's Ezekiel Emanuel and colleagues in the Journal of the American Medical Association (sadly, subscription required to read both). While I have some minor quibbles about organizational issues addressed in both articles, it's worth looking at them because it shows the bipartisan recognition of the need for comparative effectiveness research. Wilensky ran the Center for Medicare and Medicaid Services (then known as the Health Care Finance Administration) in the Bush I administration, while Emanuel is Democratic Party heavyweight Rahm Emanuel's brother. And whlie I shouldn't make presumptions about his party affiliation based on his brother, I've had lunch with EE and can confirm based on that conversation and following his articles over the years that those two apples didn't land very far apart after falling from the same tree.

Posted by gooznews at October 19, 2007 02:48 AM