It is now largely known that the big pharmas wield irresistible influence over how physicians prescribe. In a system of not so clandestine bribery and “research” validations for pharmaceutical biases, patients are relegated to over-priced and not best practices.
The nation’s $325 billion prescription-drug market offers an enormous incentive to develop and disseminate information lauding the presumed virtues of costly new medications, but there is much less muscle behind efforts to encourage the use of established, off-patent drugs, even when the weight of evidence and experience recommends them.
At the same time, the medical literature is rich with superbly conducted trials and thoughtful, balanced clinical guidelines. For a physician, trying to process this rush of inputs can feel like drinking from a fire hose into which someone occasionally squirts a stream of arsenic. Imagine Stendhal on acid.
To address this problem, which affects the care of every patient in the nation, several groups — including the Institute of Medicine, the American College of Physicians and the Cochrane Collaboration, an international network of experts that evaluates clinical research — serve a “curation” role for medical knowledge. As the evidence base becomes ever larger and more contentious, this honest-broker synthesizing function becomes increasingly important.