Reprinted from The Los Angeles Daily News  Editorial Commentary ("Op-Ed") Page October 3, 2004  

Doctors Too Cozy With Big Pharma?

By Ellen Stern Harris

Thursday morning I awoke to the news that Merck had recalled its arthritis drug, Vioxx. According to Reuters, a study has recently shown that the drug doubled the risk of heart attack and stroke.

With millions taking it, and possibly billions of dollars in liability, this news caused Merck's shares to plummet on the New York Stock Exchange. And it sent me to my nearby Rite-Aid, seeking a refund for the bottle of Vioxx I brought with me.

What has yet to be determined is how come 84 million people around the world have been taking Vioxx since 1999, when it was approved by the Food and Drug Administration, with apparently inadequate testing.

After the Vioxx recall, concerns about the prohibitive price of some prescriptions now seem to pale in comparison with the possible harm one could be doing by taking such medications. In recent writings, the former editor of the New England Journal of Medicine, Dr. Marcia Angell, has warned about how negative findings about pharmaceutical products are often concealed.

It is now time to make sure that practice is no longer permitted. But there is more that needs to be done to make it a level playing field for patients.

How can anyone be sure why one's doctor is switching one from a medication which has worked to another, newer drug? In my case, tamoxifen, which had kept a recurrence of cancer at bay since 1988, had been working fine. Then its patent ran out, and its manufacturer began to promote two new products to replace what had now become a lower-cost generic product. In my case, neither of the new drugs worked, and my cancer metastasized to my bones.

Subsequently, I decided to go back on tamoxifen, and for a while, my cancer appeared to be diminishing. However, blood tests and a recent PET/CT scan show the metastases are, once again, growing.

So, my oncologist recommended doubling my tamoxifen dosage. It's a monthlong wait for the next blood tests to reveal what is happening to me, although my daily level of "cancer fatigue" is a fairly accurate index.

Recent reports of major pharmaceutical companies paying physicians thousands of dollars to lecture gatherings of other physicians on the merits of their products is disconcerting to say the least. And paying doctors to attend all-expense-paid, lavish weekend resort events, where such lectures may take place -- under the guise of gaining credits for Continuing Medical Education -- should be publicly revealed.

For the enlightenment of patients, it may now be time for the California Legislature, if not Congress, to require physicians to provide annual full-disclosure statements. These might be similar to the conflict-of-interest or financial holdings reports provided by elected and appointed officials. They could be posted prominently on a doctor's waiting room wall, providing something more relevant to read than last year's tattered magazines.

For example, besides which pharmaceutical companies the physician is being paid by, the products of that drug company should also be listed. In the case of doctors at universities and other teaching hospitals, the names of the pharmaceutical companies funding their research should be listed along with those companies' products.

It seems that some physicians' primary clients may be part of the world's most profitable industry, big pharma. Other clients may be seen to be the HMOs, leaving the physicians' relationship to patients the least of some doctors' economic concerns.

It would also be helpful to know if one's physician has ownership in the companies to which the patient is referred for medical testing and diagnostic imaging.

Carrying this one step further, Congress should require the Securities and Exchange Commission to have pharmaceutical companies' annual reports reflect the amounts paid to which physicians -- and for what purposes. Also, these annual reports should include names of FDA and NIH officials who are paid consultants to these companies, as well as the names of those who left these agencies and subsequently went to work for the companies they formerly were charged with regulating.

"Buyer beware" works better when we know just what to be aware of.

Ellen Stern Harris is Executive Director of Fund for the Environment and a longtime consumer advocate.