Monday, August 20, 2007

The Drug Companies Did It

The New York Times has an occasionally strange piece (registration required) on new views on controlling the complications of Type II diabetes. The hypothesis summarized is that controlling blood sugar is not enough. Those with the disease most also keep their LDL cholesterol down and otherwise be mindful of heart disease.

So far, so good. But why don’t patients and doctors know this as much as they should? Numerous causes are offered, but one of the accused, bizarrely, is the drug companies:

In part it is the fault of proliferating advertisements for diabetes drugs that emphasize blood sugar control, which is difficult and expensive and has not been proven to save lives.

And then:

That leaves cholesterol lowering, for patients with Type 1 and Type 2 diabetes, as the most effective and easiest way by far to reduce the risk of heart disease and the only treatment proven to save lives. But doctors say achieving the recommended cholesterol levels usually means taking a statin. Some patients resist, wary of intense drug company marketing to patients and afraid of side effects like muscle or liver damage which, although extremely rare, have frightened many away from the drugs, Dr. Brownlee and other diabetes specialists said. (Dr. Brownlee said he had no financial ties to statin makers.)

Others point to drug company advertising itself. Statin advertising, said Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington, is all about heart disease, and the advertisements do not mention diabetes. The diabetes advertisements are all about blood sugar. Dr. Hirsch has seen few that put the two together.

Yet lowering cholesterol with statins, Dr. Hirsch and others said, is much simpler than anything else diabetes patients are asked to do. And, he added, the drugs are among the best studied and the safest on the market. (Dr. Hirsch said he had no financial ties to statin makers.)

Several points are worth making. First, the idea that blood-sugar control is critical to good health is not some distraction manufactured by drug companies; it has been the best medical knowledge for years among diabetes specialists. Second, it is not clear why drug-company ads promoting one sort of drug (those to control blood sugar) preclude finding out information about complementary drugs like statins. Indeed, as well known as the beneficial effects of statins are to medical researchers, it seems much more likely the problem is a communications breakdown between researchers and practitioners. The article acknowledges this problem, but the drug-company criticisms are completely extraneous. The drug companies, after all, make the sugar-control medicines that clearly provide significant medical benefits, even if (recalling the dangers of making the perfect the enemy of the good) they are not complete cures. Third, the implication that drug-company ads are mainly devious in design is revealing of a philosophical presumption that people are not fit to evaluate the information for themselves, but are instead passively manipulated by these firms into pressuring their doctors. How dare, in other words, patients be in charge of their own health care.

Finally, patients who are “wary of intense drug company marketing to patients” are themselves frankly part of the problem, fueled by anti-Big Pharma hysteria whipped up by, among others, The New York Times. Indeed, the article prissily assures readers that its set of sources who recommend statins (also a product of drug companies) have been meticulously scrubbed clean of any who might have financial ties to those companies, as the excerpt above illustrates. When critics of drug companies (Sidney Wolfe, say) are used for quote fodder, the advancement of their anti-corporate interests, every bit as real to them as financial interests are to drug companies, is never seen as cause for doubt.

The drug companies, which have made the lives of people all over the world immeasurably better by maximizing shareholder value, are increasingly the bête noire of those who criticize the American health system from the left, a symptom of the rising tide of obsessive-compulsive anti-corporate thinking that increasingly defines the American and global left. But here are the fundamentals of the drug companies and Type II diabetes: the sugar-control drugs are made and distributed by them; the same holds true for the statins that apparently are also needed by diabetics; and they are critical, through both their research and market-making skills, to any possible advancements in diabetic treatment. This is the big picture, but the spreading tide of anti-drug company paranoia, so vivid in the Times article, will have none of it.


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