Good for Business, Bad for Patients?

Pfizer's Plan to Buy Rival Wyeth Could Mean Bad News for Patients, Physician Says
Op-Ed By JOHN ABRAMSON, M.D.

It's perfect. Pfizer buys Wyeth's pipeline, the behemoth marketing power of
Pfizer gets leveraged, the work force gets consolidated and the $22 billion
borrowed is read as a sign that banks are willing to lend again.

Well, not quite perfect but pretty darned good.

The problem is: pretty darned good for whom? Both Pfizer and Wyeth are
attending to their primary responsibility: maximizing profits and delivering
them to shareholders. Improving Americans' health most effectively and
efficiently is not their job, but convincing us all -- including doctors --
that it is, is.

We desperately need to find a way to contain health care costs and at the
same time improve access. Seems impossible, but the almost unimaginable
level of dysfunction in American health care actually creates enormous
opportunity.

It's hard to believe that despite spending twice as much per person as the
other industrialized countries, Americans live an average of 1½ years less
in good health. And if the rate of potentially preventable deaths in the
United States were declining as quickly as it is in Austria, Ireland and
Norway -- three countries that lead in this respect, and each spend about
half as much per person on health care as the United States does -- 100,000
fewer Americans would be dying each year.

The core problem with American medicine isn't really access or cost. It's
that medical knowledge itself has been turned into a commodity, produced and
disseminated with the primary goal of optimizing profits rather than health.
Eighty-five percent of clinical trials are now commercially funded, and the
odds are four to five times greater that the commercially funded trials will
conclude that the sponsor's drug is the treatment of choice compared with
noncommercially funded trials of exactly the same drugs, according to a
lecture given at Harvard Medical School in October by Dr. Catherine D.
DeAngelis, the editor in chief of the Journal of the American Medical
Association.

That's just the beginning.
Those studies are then bundled into review articles (often sponsored by the
drug maker); presented at continuing medical education courses that are
funded directly or indirectly by the drug maker; supported by "key opinion
leaders," recognized experts who happen to be getting paid by the drug
maker; incorporated into guidelines -- the majority of expert authors having
financial ties to one or more of the drug companies making a drug being
considered in the guidelines; and, of course, touted by the drug reps lining
up to get some face time with the doctors, who -- according to the
Pharmaceutical Research and Manufacturers of America's research --
overwhelmingly find the information delivered by the reps up to date, useful
and reliable.

The Failure of the Medicine Market
What we've got is a good old-fashioned case of market failure. But
understanding the magnitude and consequences of the failure of the market to
oversee the relevance and integrity of commercially generated medical
knowledge is virtually impossible to see unless you're a corporate insider
or have a subpoena to gain access to the unspun scientific evidence (closely
held as proprietary information by the drug companies) and other corporate
documents.

Actually it's a double failure.
First, the kinds of things that get researched are those that offer the
greatest potential return on investment. So our medical knowledge grows in
the direction that is most profitable for the medical industry and all too
often, this is not the direction that will improve Americans' health most
effectively and efficiently.

Then we get into the failure to ensure the integrity of the commercially
produced medical knowledge that informs doctors' prescribing decisions. For
example, on the same day (perhaps not coincidentally) that Pfizer's plan to
acquire Wyeth was announced, Pfizer also announced a pending $2.3 billion
settlement with the Department of Justice to settle allegations that it
marketed its arthritis drug Bextra off-label (allegedly having encouraged
doctors to prescribe Bextra for conditions for which the FDA had not deemed
the drug effective). The second story got far less coverage, probably as a
result of Pfizer's fortuitous choice of that particular day to announce the
record-shattering settlement in process.

And in order to pay for Wyeth, Pfizer will borrow $22 billion from Goldman
Sachs, JP MorganChase, Citigroup and Bank of America -- all banks under
pressure to increase lending since accepting government bailout funds.

So what effect will Pfizer's acquisition of Wyeth have on American health
care?
Pfizer's purchase of Wyeth will diminish its imperative to develop new
products that genuinely improve health to replace the older blockbuster
drugs going off patent; the new Pfizer will have even greater marketing
power to convince doctors and patients to use its products (often in lieu of
less expensive and more effective approaches); attention is being
effectively deflected from Pfizer's pending $2.3 billion payment to the
Department of Justice for allegedly illegal marketing Bextra; and instead of
federal bailout money being used to save jobs, the taxpayers' money will be
used to put at least 18,000 hardworking, well-trained Americans out of work.

Pfizer's acquisition of Wyeth might be pretty darned good for the
shareholders and some of the executives, but it sure won't help the American
people.

This work is the opinion of the author and in no way reflects the opinion of
ABC News.

Dr. John Abramson, a clinical instructor at Harvard Medical School, is the
author of "Overdosed America: The Broken Promise of American Medicine" and
serves as an expert to plaintiffs' counsel in litigation involving the
pharmaceutical industry, including both Pfizer and Wyeth.