If politician’s war on drugs continue, patients will suffer

Traditionally, the “war on drugs” was aimed at illegal substances. But Sen. Charles E. Grassley (R-Iowa) has reinvented this war as a war on pharmaceuticals. He is continuing his campaign to restrict the amount of information about drugs available to doctors and patients.

His newest effort focuses on a psychiatrist at Emory University, Dr. Charles Nemeroff, who is being blamed for failure to disclose payments for consulting arrangements with drug companies. (I also teach at Emory, but I do not know and have never communicated with Nemeroff, and no one at Emory has been contacted about this article. I have consulted for Pfizer but since as an economist I cannot write prescriptions and I have not been paid for this article, no one can accuse me of conflicts of interest.) Previously, Grassley has targeted academic doctors at the Universities of Cincinnati, Harvard and Stanford. I have no knowledge of the facts in these cases beyond newspaper accounts, and I will not comment on whether the medical professionals violated National Institutes of Health rules or university policies. It is the wisdom of these rules and policies that concerns me.

The campaign to require disclosure of payments to physicians from drug companies is part of a general campaign to limit interactions between physicians and these companies. NIH policy apparently requires that physicians who have received more than $10,000 in fees from a drug company not participate in research involving the products of that company. The assumption is that such interactions (including payments for lectures or other services but also including free pens and lunches) lead to biased behavior in prescribing medicines and other aspects of medical practice. It is important to carefully examine the research literature on which this claim is based. If it were true that patients were hurt, then research would show that doctors changed their behavior after interactions with drug reps and that patients were harmed by this change.

But there is no evidence at all that any of the alleged interactions between doctors and pharmaceutical companies has had any harmful effect on any patient. Here is a direct quote from one of the leading articles on the issue: “No study used patient outcome measures.” In other words, no one has actually looked at the effect of pharmaceutical marketing on the welfare of patients. Indeed, some of the researchers writing in this area profess not to care about patient outcomes. In an interchange I had with two authors in this tradition (in the Journal of the American Medical Association) they said that “this fact [that pharmaceutical promotion influenced physicians’ drug choices] rather than the possible merits of the choices themselves, should concern us as physicians.” So we have a set of policies based on an unproven assumption.

In the case of Nemeroff, press reports indicate that he has consulted for 21 drug and device companies simultaneously. This should be enough to demonstrate that there was no conflict of interest. Since he would have received consulting fees from most or all of the companies producing drugs, he would have had no incentive to favor one over another in his prescribing practices. Nemeroff is described by the New York Times as “a charismatic speaker and a widely admired scientist who has written 850 research reports and reviews.” The reported amounts he has earned from drug companies for lectures and other services is more than he would receive in payments from NIH grants. If Grassley is successful in his policies, then physicians like Nemeroff will simply cease doing research for NIH. The result will be fewer new drugs available for patients, and less information for physicians and patients about the drugs that are developed.

Frank Lichtenberg, a health economist at Columbia University, has shown that newer drugs tend to reduce total health care costs and improve patient outcomes better than older drugs. The policies at issue here may reduce the availability and use of newer drugs because they will make it more difficult for academic physicians to undertake research on drugs and for physicians to learn about newer drugs that are developed. If this happens, patients will suffer —- a perverse outcome for policies ostensibly designed to improve patient care.

> Paul H. Rubin is Samuel Candler Dobbs professor of economics and law at Emory University and a senior fellow at the Technology Policy Institute. He has consulted for Pfizer, but received no compensation for this article.