Collateral Damage – Drug Companies, $, and Autism

The revelations last week that yet another highly-paid academic doctor and medical researcher was also getting millions of dollars in personal payments from GlaxoSmithKline and other drug companies as he was running “independent” tests on their new drugs questioned our ability to adequately test new medicines. Unfortunately, these sorts of increasingly common conflicts of interest also have the unanticipated collateral effect of eroding the confidence of the public in the medical profession as a whole.

It’s not just the drug companies who are implicated. CT angiograms – a detailed multiple x-ray of the heart – have been shown to have no clinical benefit for most patients, yet doctors in cardiology practices are routinely installing the $1 million machines in their practices and running patients through the scanners at $1,000 a pop.

When a profession becomes a business and patients become consumers it’s easier for people to question the motives of those involved in delivering care. Some of this can be a good thing. Because it releases so much radiation, a CT scan of the heart actually increases slightly the risk of getting cancer, so asking whether it really is necessary isn’t a bad idea.

But the breakdown of trust can also have enormous adverse consequences. This can be seen most readily in the widespread worries about a link between vaccines and autism in children. Despite the fact that, as recently noted, “[t]he Institute of Medicine of the National Academy of Sciences, the C.D.C. and the World Health Organization have found no evidence of a causal link between vaccines and autism,” the worry persists.

Advocates trying to prove a vaccine-autism link often cite concealed connections between drug companies and doctors. Robert F. Kennedy, Jr., a leading proponent of linking this problem, describes an “isolated” meeting in complete “secrecy” between “representatives of every major vaccine manufacturer, including GlaxoSmithKline, Merck, Wyeth and Aventis Pasteur,” and major government and private physicians.

Or, a more skeptical article in Slate recently noted that the debate, “reflects the foxhole bonds among those convinced that the government and drug companies poisoned their babies with vaccines.”

When the drug industry routinely pays millions in consulting fees to doctors, the effects are felt throughout the entire health system. Everyone cannot be their own doctor, regardless of what the apologists over on right-wing avenue crow about “consumer-directed” care. Trust is an essential element of treatment, and the actions of both some doctors and most drug companies threaten to destroy that bond.