218. "How to Fix the Pharmaceuticals" The New York Times, (February 23, 1992).

One is a lone scoundrel. Two are a couple of rotten apples. But when a whole slew of companies in an industry are caught up in highly questionable - if not criminal - acts, we should reform the system and not just those caught up in it.

In recent months, some of the best-known pharmaceutical companies - Dow Corning, Upjohn, Bolar, Hoffman-LaRoche, SmithKline and Syntex, among others - were said to have failed to report data showing their drugs or products were unsafe. Dow Corning is said to have withheld information about the dangers of silicone injections and breast implants; Upjohn, about violent side effects from its sleeping pill, Halcion; Bolar, for mislabeling and adulterating eight drugs.

What tripped them up? The system that permits companies, rather than the Food and Drug Administration or another group, to test the safety of drugs the pharmaceutical companies want to market. The evidence strongly suggests that drug companies often find it irresistible to doctor, or even conceal, unfavorable data - particularly of the alternative is endangering the prospects of a drug that has cost them a fortune to develop.

Free-market purists argue that the system needs no change, that it is self-correcting. They say that companies caught misleading the public will lose credibility - and business. But without oversight, it often takes decades before the public finds out about pharmaceutical wrongdoing. By then , thousands may suffer ill consequences.

Complicating this is the fact that pharmaceutical companies sell many products. When word leaks out that a manufacturer did not tell all about the ill-effects of a particular drug, how will the people taking other medication made by the company react? The public cannot forgo essential medications because the manufacturers withheld information about another drug. Besides, when so many companies are involved, the public may not feel much safer by switching. Clearly, we need a better way to enhance drug safety.

Why not have the pharmaceutical industry set up its own facilities? These would not be under control of any one company; there would be nothing to gain from cheating. They could be financed by fees paid by companies whose drugs are tested. Companies would save money by being able to use a shared set of labs. This system would uncouple the profit motive from testing - and keep government bureaucracy at bay. Those considering this approach utopian, and there are many, should not be surprised when the public demands and gains more regulation of this industry.

Then, the industry may be encouraged to tackle the next problem: changing the way its sales force pushes drugs on physicians by spending billions of dollars on free meals and entertainment and outright cash payments, rather than relying on the efficacy and safety of their drugs.

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