Bmj Usa: Editor's Choice


BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E244
  1. Steven H Woolf, MD, MPH

    From BMJ USA 2003;August:400

    These are revolutionary times in medicine, to say the least. One such phenomenon is the stark influence of the pharmaceutical industry. The exorbitant costs of drugs drain government budgets, strain corporate profits, and empty the wallets of the elderly and uninsured. Patients forego prescriptions that they cannot afford, and lives and health are surely lost in the process.

    Drug makers contend that they need the money to finance life-saving research, but fully 65% of new FDA drug applications are for “me-too” agents that differ from existing products only in terms of dosage, administration route, or combined ingredients. At a time when the economy is hobbling other industries, there is an unseemly appearance to the pharmaceutical industry's profits and to the inability of the sick and infirm to afford their products.

    The pharmaceutical industry reaches into every nook of health care, as in the influence of drug representatives on prescribing habits (BMJ USA p 432), of direct-to-consumer advertising on market demand, and of industry sponsorship on the performance and results of research (p 413). Such sponsorship affects which studies are submitted (BMJ USA p 424), the journals that publish the work (and accept advertising revenue) (BMJ USA p 449), and even how the results are portrayed (BMJ USA p 449). Readers intrigued by this subject will find much more to read in the May 31, 2003 theme issue of the BMJ.

    Another revolution in health care—the growing focus on the patient—was the subject of the June 14, 2003 theme issue of the BMJ (BMJ USA p 440). The ascendancy of patient-centered medicine is heartening. For too long the design of the health care system has served the needs of its power elite: insurers, Medicare, providers, hospitals, and industry. Crossing the Quality Chasm, the landmark 2001 report of the Institute of Medicine, warned that radical redesign is urgent to fulfill the vision of a system that truly serves patients, delivering the care that patients need, precisely when they need it. The power elite will need to make sacrifices if this vision is to be realized and if patients really are their first priority.

    As the globe revolves, so does BMJ USA. One such revolution occurs with this issue, as the current editor departs and a new editor, Douglas Kamerow, takes the helm. BMJ USA, established in 2001, continues its central mission: to bring the best of the BMJ to American primary care physicians. In the past year it has expanded in both recognition and content, including more original research and commentary from American authors, new features to better serve busy physicians, and online access. Dr Kamerow, a family physician with a prominent government career (see, will bring further innovations. BMJ USA remains committed to bringing readers a refreshing blend of articles that educate, entertain, and challenge dogma. This tapestry makes BMJ USA unique among the journals available to American primary care doctors.

    Articles cited in Editor's Choice are listed below, beginning with their BMJ USA page number

    BMJ USA p 432 Characteristics of general practitioners who frequently see drug industry representatives: national cross sectional study (Watkins et al)

    BMJ USA p 413 Information from drug companies and opinion leaders (Liberati et al)

    BMJ USA p 424 Pharmaceutical industry sponsorship and research outcome and quality: systematic review (Lexchin et al)

    BMJ USA p 424 Evidence b(i)ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications (Melander et al)

    BMJ USA p 449 Medical journals and pharmaceutical companies: uneasy bedfellows (Smith)

    BMJ USA p 440 The patient issue

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