Well the radical communist moderate social democrat nature of this blog has been somewhat shattered by recent contributors, and this post continues that trend. Mark McClellan (the ex-FDA commissioner and now CMS head), Cato and more radical wingnuts libertarian think tanks like the Institute for Policy Innovation (founded by ex-House GOP leader Dick Armey and funded by corporations, the Scaife family and the rest of Hillary’s VRWC) continue to think that the problem is that drugs in the rest of the world are too cheap. IPI’s latest press-release claims that prices in Canada ought to be 82% of the US level but in fact they’re only 59%. So they think of course that Canadians should voluntarily increase their payments by some 35%. I assume the IPI also thinks that WalMart should start paying its suppliers a ton more every year, or is using your purchasing power only OK if you’re in the private sector? For that matter I don’t think WalMart lets its suppliers get away without innovating, but they certainly don’t let them raise prices to do it!

While espousing the same general view, new THCB contributor Atlas turns his rather entertaining guns on the motivations of Marcia Angell and her colleagues at the New England Journal:

Marcia is no angel when it comes to this. She and fellow traveler Arnold Relman have been biting the hand that fed them for years. The NEJM, unofficial voice of Man’s Best Medical School (Harvard) and Man’s Best Hospital (Mass. Gen.)(reference: Samuel Shem, House of God) is perhaps the only paid subscription medical journal with a circulation of 130,000 plus physicians. However it has for many years accepted pharmaceutical advertising support. Yet somehow it has managed to maintain Brahmin-like integrity and the respect of physicians worldwide. So it is for many of the physicians condemned by Angell. If not, why publish them? Shills don’t make it through peer review. If the pharma companies don’t subsidize these studies, who will? The government, of course. Talk about mega conflict of interest! What incentive will a weasly, rationing American National Health Service as Angell and Relman and fellow Brahmin Kerry advocate have to publish objective research about costly new therapies? and how will NEJM keep its sub price affordable when the only ads they get are PSA’s from their new patron, Uncle Sam?

Ah, the road to serfdom is paved with fool’s gold, and Ms. Angell and Mr. Relman are skipping along it hand and hand, off to meet the Wizard in the worker’s paradise. Wait until they meet the man behind the curtain. He will make Big Pharma look like Dicken’s old Fezziwig compared to Uncle Scrooge

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Now Atlas points out a very big dilemma–how can journals remain objective while taking money from those they are reviewing. Really only Consumer Reports (with its no advertising, subscription only model) can claim that level of objectivity. Funnily enough the issue is one that I found in an email sent to me from The Industry Veteran late in 2003 (hitherto unpublished in THCB). Concerning the then controversy about Crestor and The Lancet, and in response to a suggestion that the Lancet was attacking A-Z’s Crestor purely on the desire to cuddle up to Pfizer The Veteran wrote:

I don’t for one minute think that the Lancet’s editors are impervious to the pressures of their publishers, and Reed-Elsevier’s business ethics are similar to Tony Soprano’s. Saying that, it remains a fact that only a fool would believe an unscrupulous company always takes the rotten course of action. If the editors are mere henchmen for a corrupt publisher, then I have to question why a company with so many business entities dependent upon the promotional spending of pharmaceutical manufacturers would go out of its way to antagonize a drug maker with an announced $1 billion promotional budget for its Crestor launch. Prestige journals such as Lancet and the New England Journal, and thought leaders in academic medicine, earn their money in the manner of whores by going to bed with every big spender they can. Reed-Elsevier can squeeze more ad pages out of Pfizer for Lipitor and Caduet (as well as Merck/Schering for Zocor-Zetia) in the event of a lavish Crestor splash rather than in the absence of one. Of course Noam Chomsky (and David Hume way before him) is correct in pointing out that the media manufacture consent. That just means we have to rely on diverse outlets and know how to read them instead of thinking reflexively and without context.

The careful TCHB reader may notice a strange confluence between Atlas’ and The Industry Veteran‘s views on medical journals. I assure you that these are two very different people but it warms the cockles of my heart to see that cynicism is very much alive on the right as well as on the left!