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.

Jan. 30, 2009 —

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 1 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.