In some ways, American healthcare is the best in the world. There is no other country I would choose for my medical treatment than the good ole’ U.S.A. There is no doubt that doctors come to this country to receive the best medical training in the world. We are blessed with the best in medical technology, and it is readily available.
But in other ways we are falling behind the rest of the world. I have made these observations before and written about them in my most recent book, Changing Healthcare. But recently I learned some disturbing news about our pharmaceutical industry and their interactions with the academic medical journals I was not aware of.
Dr. John Abramson is a faculty member of the prestigious Harvard Medical School, currently teaching healthcare policy. In a recent speech at Hillsdale College, he reported disturbing news about changes that have occurred in the way medical research studies, particularly regarding new drugs, are reported in the medical literature.
The time-honored method of reporting medical literature is for researchers to submit their studies to medical journals for publication. Before they are accepted for publication, their editors carefully review the data provided by the researchers and compare their data to others previously published. The results are scrutinized by the editors and their expert analysts for flaws in the study design or misinterpretation of the results. There is no financial bias in this process for no money is exchanged for accepting articles for publication. The medical journals make their money off subscriptions and reprints of the articles they publish. The study authors receive no compensation for their published articles. (I have published several articles in the medical journals.)
But Dr. Abramson says all that began to change in 1981. At that time, Derek Bok, the president of Harvard University said in Harvard Magazine that the university’s reliance on industry funding for research was causing “an uneasy sense that programs to exploit (make money from) technological development are likely to confuse the university’s central commitment to the pursuit of knowledge.” He explained that because grants from the National Institutes of Health (NIH) and the National Science Foundation (NSF) were declining, scientific researchers were turning to commercial sources for funding. Today, it is common for medical schools to have commercial relationships.
How has this impacted medicine?
A 2005 article in the New England Journal of Medicine (a leading medical journal) noted that 80 percent of clinical trial agreements allowed drug companies to own the data produced by the research. Abramsons says, “In my mind, data from a clinical trial – excluding of course, manufacturing techniques and genuinely proprietary information – is a public good, because doctors are going to use that data to make decisions about how to treat their patients. But the drug companies don’t see it that way.”
In the same NEJM article, two other findings are worth noting. In 24 percent of clinical trial agreements, the sponsor (the drug company) “may include its own statistical analysis in manuscripts (journal articles).” And even more outrageously, 50 percent of clinical trial agreements allow the sponsor to “write up the results for publication and the investigators may review the manuscript and suggest revisions.”
Abramson explains, “In other words, 50 percent of the contracts that academic medical centers make with drug companies allow the drug companies to ghost write the articles. The researchers who are the named authors of the articles have the right to suggest revisions, but not to make actual corrections or edits. This is not academic freedom. Nor is it an arrangement in which medical science is going to serve the interests of the American people.”
You might ask why don’t the researchers, or at least the medical journals, simply refuse to accept articles without full disclosure and full authority to publish results that are supported by the data? The response of one respected editor of a medical journal to this very question was, “That would be a death spiral for the journal.” In other words, the editors of these journals have sold out their integrity for the sake of their budget. Therefore, the integrity of their published studies can no longer be respected and relied upon.
How is this impacting the quality of our healthcare system?
In 1980, the U.S. was just about equal with eleven other wealthy countries in terms of life expectancy. But since then, our life expectancy has fallen in comparison. Until 2014, our life expectancy was still improving, but we were losing ground to the populations of other advanced countries. By 2019, just prior to the Covid pandemic, life expectancy in the U.S. had fallen relative to that in the other countries so much that 500,000 Americans were dying each year in excess of the death rates of the citizens of those other countries.
Combine this with the fact that in the U.S. we are paying an average of $12,914 per person per year on healthcare, whereas that figure in the other comparable countries is $6,125. That’s $6,800 more per person – multiplied by 334 million Americans – which comes to an excess of $2.3 Trillion a year on healthcare – for poorer results! That’s a broken healthcare system!
(Note: For more on this subject, read Part II of this series.)
