The Medical Cynic: Your Pharmacy Dollars at Work


By BonesMcCoy, Section Medical Clinic/Health issues
Posted on Wed Jun 01, 2005 at 06:58:34 AM CST

Tonight was the regular meeting of the county medical society.  It is made up, largely, of good people who want to do good for people.  And they want to keep current with the changes in medicine.

The meeting included a speaker, a respected specialist from a large clinic, who wants very much to provide good medical care, and to help others to do the same.  He spoke on the importance of vitamin D in keeping bones healthy, showed research showing not only deficiency in this vitamin among many, but also its effects on muscle strength, and on falls in the elderly.  So what's wrong with this picture?

A couple of other good people were there, who picked up the bill for the somewhat lavish dinner, and paid the speaker his honorarium.  I know these two, and they are honorable, hard-working people.  Their employer is a pharmaceutical company.  Now, this company is not malicious, and really does some good things.  

Well, this company sells an osteoporosis drug, and has been a advocate for bone density testing, and treating osteoporosis to prevent fractures - not a bad thing, in principle.  Funny thing, though - they never had put emphasis on vitamin D before now, even though the data have been accumulating for some time.  Just coincidentally, I'm sure, this company just added vitamin D to its drug, which they loudly point out as distinguishing it from its competitor in this billion-dollar market.  

Another funny thing - you would think the speaker would have put the emphasis on a healthy diet, good exercise, adequate sunshine, and vitamin D supplements when needed.  While acknowledging the role for vitamin D supplements, he pointed to this new formulation of the drug as a major part of the solution.  He presented the same data that these drug reps show me when they come around to my clinic.  The data are no more convincing when presented by an expert than they are when presented by a drug detail person.

I am a strong believer in preventing fractures in the elderly.  I prescribe quite a bit of medication for this, in the context of a program of diet, exercise, and so on.  I came away from this talk with two important points.  First, to achieve the desired results, the osteoporosis drugs are less important than increasing vitamin D intake to around 1000 or 1200 units per day (along with adequate calcium, and avoiding extra vitamin A intake).  For many, these drugs will help avoid very painful and debilitating fractures, but they are secondary.  Second, I never cease to be amazed at how many in the medical community will uncritically buy the claims presented by those paid to promote the drug company's agenda.  Again, the speaker is a good man, and believes strongly in the importance of what he is promoting.  But somehow, the drug profits seem to affect everyone involved in this evening's dinner.

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