The Patient–Physician–Industry–Government Partnership: A Societal Good
Article Outline
I recently celebrated the 40th anniversary of my graduation from medical school at a class reunion in Boston. While reminiscing with my former classmates about the joys and tribulations of living as a student during the 1960s, a discussion arose regarding what was available to us then in the area of pharmacotherapeutics compared with what is now available for practicing physicians. In regard to treatments for cardiovascular disease, my area of internal medicine subspecialty, we had nitrates for angina pectoris; digitalis preparations and furosemide for heart failure; hydrochlorothiazide, reserpine, guanethidine, hydralazine, and alpha-methyldopa for hypertension; quinidine, lidocaine, and procainamide for arrhythmias; and bile acid resins for hypercholesterolemia. Since 1969, with the advances in basic research supported by the National Institutes of Health (NIH) and the development of new drugs by the pharmaceutical industry, we now have available for clinical use the beta-adrenergic blockers and calcium-entry blockers for the treatment of angina pectoris; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for heart failure; new drugs for systemic and pulmonary hypertension; thrombolytics for myocardial infarction; statins for hypercholesterolemia; and new antiplatelet drugs. These newer therapies have favorably affected both the prevention and treatment of cardiovascular disease.
As examples, over the past 40 years, major reductions have occurred in the numbers of acute myocardial infarctions, in part related to innovative drug therapies for cholesterol elevations, hypertension, and smoking addiction. If an acute myocardial infarction does occur, there is now a highly significant chance a patient will survive the event with the use of thrombolytics, antiplatelet drugs, beta-blockers, and drug-eluting stents. In individuals with class IV heart failure, a condition with an extremely high 1-year mortality rate if left untreated, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers have been shown to reduce the mortality rate while improving the functional capacity of patients.
As a Chief of Medicine at a Bronx teaching hospital in 1982, I was an early eyewitness to the horrors of the human acquired immunodeficiency disease syndrome (AIDS). It was the intense drug development efforts by the pharmaceutical industry, in tandem with the discoveries by investigators at the NIH and elsewhere, that has made AIDS an outpatient condition with a significantly reduced mortality risk. Similar advances have occurred in the therapy of cancer, rheumatologic diseases, infectious diseases, and almost every other area of medicine. Indeed, for more than 100 years there has been an unwritten understanding in the United States that the pharmaceutical industry, in a market economy, would develop the treatments that patients and their physicians require, and that the government would supervise the approval process and regulate the marketing and manufacturing of drugs.
At the same time, industry also has helped to support an unfunded educational mandate from our professional accrediting organizations by providing the missing financial support for graduate and continuing medical education, while helping to support our scientific societies, scientific meetings, and our erudite and not-so-erudite medical publications. Clearly, in the past there were marketing excesses by industry and major physician and physician–researcher conflicts of interest that needed to be reined in.1, 2, 3 Overall, however, the patient–physician–industry–government partnership has been a great success, a union that has benefited many.
In this issue of The American Journal of Medicine, Ross et al.,4 using a survey research methodology, demonstrated at one major academic medical center that academic faculty appreciate the collaborations that exist between physicians and the pharmaceutical industry; they do not perceive this interaction as an innate evil, as long as conflicts of interest are addressed and the relationships between physicians and industry are transparent.
If the pharmaceutical industry stopped developing drugs because they had no incentive to do so, what would replace it? The government, struggling with a world economic crisis, cannot fill in the gap. I am certain that our politicians do not want to nationalize the pharmaceutical industry as they did General Motors and Chrysler. Similarly, the NIH, which has been in the forefront of basic science research, could not step in without a major overhaul of its mission.
In my view, and that of many of my colleagues, society clearly benefited from the drug discovery process sponsored by industry over the past century. With the appropriate regulatory safeguards by the government on industry and physicians, society should continue to benefit from the ongoing partnership of patients, physicians, industry, and government. However, that beneficial relationship is now being threatened by attacks from some uninformed pundits who have demonized all physicians and the pharmaceutical industry as co-conspirators in some unholy cabal aimed at exploiting and injuring patients. These persistent, and at times irresponsible attacks, can potentially bring down a US pharmaceutical industry that has for years been looked on by the entire world as a source of strength in medical research and in the advancement of clinical therapeutics. With the threatened breakdown of the partnership, what new drugs will be available for our patients when my classmates and I reassemble in Boston for our 50th reunion in 2019?
References
- . America's other drug problem. The New Republic. December 16, 2002;27–41
- . Doctors and the drug industry: how can we handle potential conflicts of interest?. (editorial) Am J Med. 2005;118:99–100
- . Doctors and drug companies. N Engl J Med. 2004;351:1885–1890
- . Appropriateness of collaborations between industry and the medical profession: physicians' perceptions. Am J Med. 2009;122:955–960
Funding: None.
Conflict of Interest: Dr Frishman is Chairman of Medicine at the New York Medical College in Valhalla, New York. He is also a member of the Speakers Bureau for Bristol Myers Squibb and Forest Laboratories, and has served as a paid consultant for Glaxo Laboratories and Boehringer Ingelheim.
PII: S0002-9343(09)00682-2
doi:10.1016/j.amjmed.2009.07.012
© 2009 Elsevier Inc. All rights reserved.