Altruism and Self Interest in Medical Decision Making

Avorn J. , “Advertising and Prescription Drugs: Promotion, Education, and the Public's Health,” Health Affairs, February 26, 2003 (Web Exclusive): 108, available at <http://content.healthaffairs.org/cgi/search?andorexactfulltext=and&resourcetype=1&disp_type=&author1=avorn&fulltext=&pubdate_year=2003&volume=&firstpage=> (last visited June 10, 2009). For many, I suspect that such criticisms are consistent with general dislike of markets, discussed below.

For an argument that reliance on markets is preferable to reliance on tools preferred by ethicists in providing body parts, see Hylton K. N. , “Biomedical Ethics and the Law: A Critical Perspective”, Annual Review of Law and Ethics (Jahrbuch für Recht und Ethik) 15 (2007): 611–631.

Excerpted Remarks of Billy Tauzin, President and Chief Executive Officer Pharmaceutical Research and Manufacturers of America, PhRMA 2007 Annual Meeting, Washington, D.C., March 16, 2007, available at <http://www.phrma.org/about_phrma/straight_talk_from_billy_tauzin/serving_patients_our_central_mission/> (last visited June 3, 2009).

IMS, Topline Data, available at <http://imshealth.com/ims/portal/front/articleC/0,2777,6599_80402580_81493254,00.html> (last visited June 3, 2009).

For a critique of all aspects of the drug industry, see Angell M. , The Truth About the Drug Companies: How They Deceive Us and What to Do about It (New York: Random House, 2005). This book is a polemic against the drug industry by Dr. Angell, the former editor of the New England Journal of Medicine. She is a major critic of the view I am espousing here, that self interest by the drug companies will lead to social benefits. While there are many critics of the drug industry I will rely on Dr. Angell as a foil since she is a respected member of the medical community and expresses (albeit often in an extreme form) most of the criticisms that are generally applied to the industry. Her discussion of “me too” drugs is in Chapter 5 of her book.

Id., at 35–36. She makes this point in the context of discussing the benefits of the FDA, but it also applies to other issues regarding learning about drugs.

Jerry Avorn is an advocate of the provision of more objective information about drugs to consumers, but he does not explain where the money will come from. For example, Avorn J. , “Advertising and Prescription Drugs: Promotion, Education, and the Public's Health”, Health Affairs, February 26, 2003 (Web Exclusive), at 106, available at <http://content.healthaffairs.org/cgi/search?andorexactfulltext=and&resourcetype=1&disp_type=&author1=avorn&fulltext=&pubdate_year=2003&volume=&firstpage=> (last visited June 10, 2009).

For example, Soumerai S. B. and Avorn J. , “Economic and Policy Analysis of University-Based Drug ‘Detailing,’” Medical Care 24, no. 4 (1986): 313–331.

Demsetz H. , “Information and Efficiency: Another Viewpoint,” Journal of Law and Economics 12, no. 1 (1969); 1–22.

The classic source is Akerlof G. , “The Market for Lemons: Qualitative Uncertainty and the Market Mechanism,” Quarterly Journal of Economics 84, no. 3 (1970): 488–500.

Nelson P. , “Information and Consumer Behavior,” Journal of Political Economy 78, no. 2 (1970): 311–329; Klein B. and Leffler K. B. , “The Role of Market Forces in Assuring Contractual Performance”, Journal of Political Economy 89, no. 4 (1981): 615–641.

This issue is discussed more generally in Rubin P. H. , “Regulation of Information and Advertising”, Competition Policy International 4, no. 1 (2008): 168–192.

Lichtenberg F. R. and Virabhak S. , “Pharmaceutical-Embodied Technical Progress, Longevity, and Quality of Life: Drugs as ‘Equipment for Your Health,’” Managerial and Decision Economics 28, nos. 4–5 (2007): 371–392.

Lichtenberg F. R. , “Benefits and Costs of Newer Drugs: An Update,” Managerial and Decision Economics 28, no. 4–5 (2007): 485–490.

See Angell , supra note 5, at 124.

The original copyright on Angell's book is 2004. Lichtenberg published results in 2001 in Lichtenberg F. , “Are the Benefits of Newer Drugs Worth Their Costs? Evidence from the 1996 MEPS”, Health Affairs 20, no. 5 (2001): 241–251. Health Affairs is a leading journal in the medical field and so no competent scholar would have said that there is “no good reason” to think that newer drugs are better.

See Angell , supra note 5, at 130.

Rubin P. H. , “An Uncertain Diagnosis” Regulation 28, no. 2 (2005): 34–39.

Wazana A. , “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” Journal of the American Medical Association 283, no. 3 (2000): 373–380.

Id., at 378.

For an interesting approach, see the website <www.nofreelunch.org>, a website of a group of health care professionals who are opposed to pharmaceutical promotion. This website does have an excellent and apparently unbiased searchable bibliography on the issue.

Chren M.-Margaret and Landefeld C. S. , “Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formularies,” Journal of the American Medical Association 271, no. 9 (1994): 684–689.

Rubin P. H. , “Letter to the Editor,” Journal of the American Medical Association 272, no. 5 (1994): 355.

Chren M.-M. and Landefeld C. S. , “Reply,” Journal of the American Medical Association 272, no. 5 (1994): 355.

See Angell , supra note 5, at 125.

The first published paper to point out the possible benefits was Masson A. and Rubin P. H. , “Matching Prescription Drugs and Consumers: The Benefits of Direct Advertising,” New England Journal of Medicine 313, no. 8 (1985): 513–515. For a recent article showing that benefits of this advertising are greater than costs, see Atherly A. and Rubin P. H. , “The Cost-Effectiveness of Direct-to-Consumer Advertising for Prescription Drugs”, Medical Care Research and Review (2009) (in press.)

National Health Council Statement, Direct-To-Consumer Prescription Drug Advertising, January 2002, available at <http://www.nationalhealthcouncil.org/advocacy/dtc.htm> (last visited June 8, 2009).

See Angell , supra note 5, at 124.

This is discussed in great detail in my book, Rubin P. , Darwinian Politics: The Evolutionary Origin of Freedom (New Jersey: Rutgers University Press, 2002). I have applied it more specifically to economic beliefs in Rubin P. H. , “Folk Economics,” Southern Economic Journal 70, no. 1 (2003): 157–171.

Caplan B. , The Myth of the Rational Voter (Princeton: Princeton University Press, 2007): 30–36.

Gowlett J. A. J. , “Tools—the Paleolithic Record,” in Jones S. Martin R. and Pilbeam D. , The Cambridge Encyclopedia of Human Evolution (Cambridge, U.K.: Cambridge University Press, 1992): 350–360.

Giaccotto C. Santerre R. E. and Vernon J. A. , “Drug Prices and Research and Development Investment Behavior in the Pharmaceutical Industry,” Journal of Law and Economics 48, no. 1 (2005): 195–214.

Pinker S. , The Blank Slate: The Modern Denial of Human Nature (New York: Penguin, 2002).

Huddle T. S. , “Drug Reps and the University Medical Care Center: A Case for Management Rather than Prohibition,” Perspectives in Biology and Medicine 51, no. 2 (2008): 251–260.

Kessel R. A. , “Price Discrimination in Medicine,” Journal of Law and Economics 1, no. 1 (1958): 20–53.

This point is often attributed to Friedman M. , “The Social Responsibility of Business Is to Increase Its Profits,” New York Times Magazine, September 13, 1970, at SM17.

Beauchamp T. L. and Childress J. F. , Principles of Biomedical Ethics, 5th ed. (New York: Oxford University Press, 2001): at 28. Motives are considered again on page 50 for organ donors.

Trivers R. L. , “The Evolution of Reciprocal Altruism,” Quarterly Review of Biology 46, no. 1 (1971): 35–57.

Trivers R. , “The Elements of a Scientific Theory of Self-Deception,” in LeCroy D. and Moller P. , eds., Evolutionary Perspectives on Human Reproductive Behavior, Annals of the New York Academy of Sciences 907 (New York: Academy of Sciences Press, 2000): at 114–131.