It’s a $50-million business with a roster of blue-chip consultants who would be an envied faculty at most any major university. But look closely at the activities of Precision Health Economics because this firm’s esteemed academic economists, for big bucks, are boosting Big Pharma’s efforts to justify some of its sky-high prices for its products to policy-makers, regulators, and lawmakers.
Pro Publica, the Pulitzer Prize-winning online investigative site, deserves credit for raising questions about yet another area in which ordinary Americans may be outgunned by special-interest money. Big Pharma already has earned notoriety for seeking to advance its causes by paying physicians, underwriting patient advocacy groups—and now retaining high-powered economists.
Economists play a key role in providing expert views on drugs, their prices, and markets, all of which are increasingly controversial issues as Americans struggle to afford medications that can cost $1,000 a day or tens of thousands of dollars for treatment regimens lasting for a few months.
Precision Health, however, has taken this provision of economic expertise to a new level, Pro Publica reports in a long, detailed story on the 85-member firm’s work for more than two dozen Big Pharma clients, including: Abbott Nutrition, AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Celgene, Gilead, Intuitive Surgical, Janssen, Merck, the National Pharmaceutical Council, Novartis, Otsuka, Pfizer, PhRMA, rEVO Biologics, Shire and Takeda.
The firm has recruited two dozen elite academics with ties to Harvard, Stanford, USC, and UCLA to advise it and its clients on drug pricing issues. It also has pulled in as associates: a top Congressional Budget Office official, a senior economist from the White House’s Council of Economic Advisors, and an FDA commissioner.
These notable experts testify at the state and federal level about drug prices, costs, and markets, sometimes relying on complex economic models that have drawn some professional fire for their accuracy and the reproducibility of their results, Pro Publica says.
Precision Health also isn’t consistently upfront about its role in public controversies involving its clients: Its experts pursue vigorous professional lives, sometimes disclosing in conferences, talks, and writings that their research occurs on behalf of Big Pharma—but sometimes not, particularly in publications in influential academic journals where results get cited widely and become part of an accepted body of knowledge., Pro Publica says.
The firm, which has pulled its bold mentions of its consultants’ academic affiliations from its site, says its staff meet rigorous professional and ethical disclosure standards. It adds that the work its blue top-notch academics perform for Big Pharma clients helps keep the experts from becoming Ivy Tower-isolated and unrealistic.
But I have written how it is becoming increasingly clear how big-money corporations work to their own maximum benefit, in part by paying for influential experts to provide buttressing studies. Big Tobacco championed this tactic to try to undercut overpowering scientific evidence of cigarettes’ harms. Medical historians only recently have discovered that Big Sugar paid some now-deceased Harvard nutrition experts to point the finger away from sugar and toward saturated fat as a leading cause of heart disease. Both the National Football League, and the National Hockey League, have resorted to “astroturfing” or attacking advocates with research-based evidence that repeated head trauma can have long-term harms for players.
In my practice, I see the huge sway that experts’ testimony can exert, sometimes to the detriment of patients who have been harmed while seeking medical care. Experts in court, of course, can be skillfully cross-examined, and their dubious or boundary-testing notions can be corralled, especially by the common sense of jurors and judges.
But in the public arena, experts need to protect their reputations, their institutions, and the greater good by rigorous, regular, and full disclosure of conflicts of interest and potential conflicts. They owe it to the public to err on the side of caution in ensuring that it is clear who their clients are. If economists truly are providing informed, independent, and high quality expert advice, and they aren’t in Big Pharma’s thrall, this should not be a problem for them.