An op-ed again in the Los Angeles Times by Shannon Brownlee called for the creation of a US national Institute for Effective Medicine. Brownlee wrote,
With two-thirds of clinical trials and three-quarters of the papers published in the top medical journals commercially funded, the drug industry has gained unprecedented leverage over what doctors and patients know — and don't know — about drugs.It sounds like an idea worthy of serious discussion.
Researchers scoff at the notion that that their scientific integrity is for sale. Certainly most researchers aren't corrupt, but their institutions are guilty of allowing the drug industry to manipulate medical science.
Meanwhile, industry-funded research is failing to provide the clinically useful answers physicians and patients need in order to pick the best treatment. Which drug is right for which patient? What are the risks? Are the added benefits of a new, expensive drug worth the cost? If not, should insurance companies and Medicare be paying for them?
What's needed is a new Institute for Effective Medicine, which would need to be modeled on the Federal Reserve Board or the Securities and Exchange Commission to protect it from political pressure. Its mission would be threefold. It would serve as a new, independent source of research dollars for medicine. It would provide independent evaluation of data generated by industry. And it would oversee the creation of clinical practice guidelines, a manual of proven "best practices" for physicians devised entirely without industry influence.
If insurance companies and the federal government set aside just one-half of 1% of their current annual spending on prescription drugs, they could endow a new institute with roughly half-a-billion dollars. Doctors, employers and insurers all have a stake in this — but not as much as patients do. Americans spend a staggering $200 billion a year on prescription drugs, and that figure is going up about 12% annually, faster than any other healthcare cost. With studies like the NIH's, physicians could prescribe on the basis of solid science, while private insurers and Medicare would have the data they need to rein in costs without sacrificing healthcare quality.
Congress may be reluctant to fund a new agency — particularly one the drug industry may hate— but an Institute for Effective Medicine would be worth its freight in better healthcare and lower costs.